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SANATIVE INFLUENCE 



CLIMATE. 



SIR JAMES CLARK, BART., M.D., F.R.S., 

PHYSICIAN IN ORDINARY TO THfi«i«l^|ft ttfrRttjragW PRINCE ALBERT. 




FROM THE LAST LOx\DON EDITION. 



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ED. BARRINGTON & GEO. D. HASWELL. 
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ADVERTISEMENT 

TO 

THE THIRD EDITION 



For the present edition, this work has been almost en- 
tirely re-written, and whatever appeared not directly to 
the purpose has been omitted, in order to make room for 
the consideration of several new subjects, and the introduc- 
tion of notices of some places not previously described. 

In an appendix, a brief account has been given of the 
climates of our colonies in the southern hemisphere ; and, 
in another short appendix, a few remarks have been made 
on the application of some of the most efficient mineral 
waters of the Continent to the alleviation and cure of the 
principal diseases treated of in this volume. The meteoro- 
logical tables have received several important additions and 
amendments. 

Since the publication of the last edition, I have con- 
tinued to receive from numerous medical friends, and 
others, who had resided some time abroad for their health, 
the most satisfactory assurances of the accuracy of my de- 
scriptions of the different climates, and their influence on 
disease. My own additional experience has been in per- 
fect accordance with this testimony. Madeira is almost 
the only place respecting which statements do not quite 
agree ; but after carefully weighing all the information 
which I have received, I have not found sufficient reason 
to change my opinion of the climate of that island. 

For the valuable new matter which enriches this edition 
of my work, I am under obligations to various friends, to 
whom particular acknowledgments are made at the proper 
places. To the kindness of my friend Dr. Davy, I am 
indebted for the advantage of perusing his interesting 



IV ADVERTISEMENT. 

work, still in manuscript, on the military stations in the 
Mediterranean. The work unfortunately reached me at 
too late a period to allow me to avail myself of the infor- 
mation contained in it; but I had 'the satisfaction to find 
that Dr. Davy's views regarding the Mediterranean climate 
are in perfect accordance with my own. Respecting the 
infrequency of pulmonary diseases among our troops sta- 
tioned in the Ionian Islands, compared with the other 
Mediterranean stations, Dr. Davy's experience agrees with 
the conclusions drawn in the Statistical Reports on the 
Health of the Army. To Major Tulloch, who has so ably 
drawn up these reports, I take this occasion to express my 
obligations for his readiness at all times in supplying me 
with information on the climates of our different colonies, 
and the health of our troops stationed there. To my friend, 
Dr. Martin, of Undercliff, I am also greatly indebted for 
his assistance in revising and extending the meteorological 
tables. 

J. C. 
London, May 1st, 1841. 



PREFACE 

TO 

THE FIRST EDITION. 



It is nearly nine years since I published a small volume of 
" Notes" on the Climate and Medical Institutions of France and 
Italy. This met with a very favourable reception ; more, I be- 
lieve, from the want of such a work, than from any merit it pos- 
sessed. Since that time I have had ample opportunities of observ- 
ing the nature of the climate of the South of Europe, and its 
effects on disease : and during the three years which have elapsed 
since my return from the Continent, I have endeavoured to make 
myself acquainted with the milder parts of England, with the view 
of ascertaining their respective merits, and of comparing them with 
the climates of the south. The present work may, therefore, be 
considered as exhibiting the result of much more extended obser- 
vation and experience than its predecessor. 

But although I have endeavoured to take a more comprehensive 
and philosophical view of my subject, I wish this work still to be 
regarded as an Essay, which future and yet more extensive obser- 
vation only can perfect. If, however, it shall be found that I have 
investigated the subject faithfully and closely, as far as I have 
gone, and if the results of my researches, and my experience; now 
recorded, shall prove useful to future inquirers, and serve as a 
guide to my medical brethren in the application of climate to the 
prevention and cure of disease, I trust I may be considered as hav- 
ing accomplished all that could be reasonably expected of me, in 
an inquiry of such extent and difficulty. 

The following work is divided into two parts. In the first, 1 I 
have endeavoured to determine the general physical characters of 
the milder climates of England, and of the south of Europe — to 
point out the manner in which the climate of different places 

1 The order of the two parts has, in the present edition, been reversed. 



VI PREFACE. 

resorted to by invalids is modified by local circumstances ; and to 
compare these places relatively to their influence on disease. 

This part is illustrated by a series of meteorological tables 
(which will be found in the Appendix) more comprehensive and 
perfect, I believe, than have before been published ; and for the 
construction of which I am indebted to the kindness of my friend 
Dr. Todd. 

In the second part, I have given some account of the principal 
diseases which are benefited by a mild climate. This I found to 
be unavoidable; it being impossible, otherwise, to give precise 
directions for the application of particular climates to the cure of 
particular diseases — and much more so to their varieties and com 
plications. 

In my endeavours to distinguish the characters of some of these 
diseases in relation to the effects of climate upon them, it may ap- 
pear that I have been unnecessarily minute ; but I have made such 
distinctions only as my experience warranted; and I have made 
them, because I feel satisfied that without strict attention to distinc- 
tions of this kind, climate can never be successfully applied as a 
remedial agent. 

In treating of two diseases (or rather classes of diseases) I have 
gone more into detail than the nature of my work may, at first 
sight, appear to require ; but the great importance of these affec- 
tions, their extreme frequency in this country, and the close rela- 
tion in which they stand to climate, considered as a remedy, ap- 
peared to me to claim for them all the consideration which I have 
bestowed upon them. 

The diseases to which I allude are consumption, and disorders 
of the digestive organs. Under this last title, I comprehend the 
various affections designated by the terms " indigestion," " bilious 
complaints," &c. In the article on consumption, I have endea- 
voured to show that the disordered states of the stomach are inti- 
mately connected with the origin of diseases of the chest, and with 
tuberculous affections generally. On this account alone disorders 
of the digestive organs would claim particular notice in a work of 
this kind ; but on their own account they are no less entitled to 
attention, seeing the amount of suffering and of evil which they 
produce, and the great benefit which I have shown may be derived 
from change of air and of climate in the treatment of them. 

With respect to the subject of consumption, it will probably be 
considered the most legitimate of any, in a work treating of the 
effects of climate. On this occasion, I have directed my inquiries 



PREFACE. Vll 

chiefly to the causes and origin of this fatal disease, with the view 
of establishing rules for its prevention ; being well satisfied that it 
is only, by a knowledge of the causes which lead to it, and by 
directing our efforts to counteract them, that we shall be able to 
diminish the ravages of consumption. On this most important in- 
quiry, therefore, I have entered as fully as the nature of my work 
would admit, and have endeavoured, to the best of my abilities, to 
fill up the blank which has been left in the natural history of con- 
sumption — that, namely, between a state of health, and of esta- 
blished and sensible disease of the lungs. 

I feel convinced that by adopting such a system of management, 
from early infancy, as I have laid down in the following pages, a 
great improvement might be effected in the general health of many 
among the higher and middle classes of society in this country. 
The children of delicate, and even of diseased parents, might, by 
proper care, be reared so as to overcome, in a large proportion of 
cases, their hereditary disposition to disease. The ultimate effect 
of this, in diminishing the vast and increasing extent of hereditary 
diseases, need not be pointed out. 

Instructions respecting the necessary preparation of invalids for 
a change of climate — for their guidance during the journey, and 
during their residence abroad, will be found as minutely laid down 
as the nature of the subject would- admit. During my residence 
on the Continent, I found these matters greatly neglected. They 
are, however, of the very first consequence to invalids, as without 
attention to them, the best climate will be productive of little 
benefit. 

It was originally my intention to have added a third part, giving 
some account of the principal mineral waters of the Continent ; 
but I found, on arranging my materials on this subject, that I could 
not have condensed them sufficiently for this purpose, without 
greatly diminishing their value. I have therefore resolved to lay 
them before the public in a separate volume ; and have satisfied 
myself, on the present occasion, with merely indicating the mineral 
waters most suitable to the different diseases treated of. This class 
of ^remedies will be found to co-operate powerfully with a mild 
climate in the removal of many chronic disorders. 

This is the proper place to notice the kind and liberal assistance 
which I have received from many friends, while engaged in col- 
lecting materials for this work. To Drs. Heineken and Renton of 
Madeira, Dr. Skirving of Nice, Dr. Peebles of Rome, and Dr. Play- 
fair of Florence, I am indebted for much valuable information. 



Vlll PREFACE. 

By the assistance chiefly of the two first named gentlemen, I have 
been enabled to give more precise information respecting the climate 
of Madeira, and its influence on disease, than has, I believe, been 
previously laid before the public. From Dr. Forbes of Chichester, 
Dr. Lempriere of Newport, and Dr. Down of Southampton, I have 
received much information respecting several of the English cli- 
mates. But the gentleman to whom I am indebted above all 
others, is my esteemed friend, Dr. Todd of Brighton, who has, with 
one or two exceptions, resided for some time at all the places on 
the Continent noticed in the following pages, and who has unre- 
servedly communicated to me the result of his observations and 
extensive experience; so that there is scarcely an article in the 
work which has not been improved by his suggestions. 1 I also 
avail myself of the present occasion, with much pleasure, to ac- 
knowledge the information which I liberally received from my 
continental brethren. To my valued friends, Professor De Mat- 
thaeis of Rome, Dr. Lanza of Naples, Dr. Mojon of Genoa, and 
Professor Grotanelli of Sienna, I am more particularly indebted in 
this way. Indeed, the friendly and liberal intercourse which I en- 
joyed, while on the Continent, with my professional brethren, is 
one of the circumstances connected with my residence abroad, the 
retrospect of which affords me the greatest satisfaction. I can 
assure such of the profession of this country as may visit the Con- 
tinent, that they will very generally experience there the greatest 
facility in prosecuting their professional researches ; and, I take 
leave to add, that, if they carry with them minds free from preju- 
dice, and a sufficient degree of practical knowledge to enable them 
to profit by what they observe, they will not fail to improve them- 
selves. 

I hope it will be found that I have succeeded in throwing some 
light on the obscure subject of the influence of climate on human 
health, and on the application of it to the treatment of disease. I 
would also hope, from the minute manner in which I have de- 
scribed the characters of the different climates frequented by inva- 

1 By Dr. Todd's death, which occurred last August, (1840,) the author 
of this work has lost a much valued friend, and medical science one of its 
most ardent cultivators. Dr. Todd had long been engaged in a series of 
researches on some of the most important points of Physiology and Patho- 
logy ; and the collection of microscopical preparations which he has left, 
shows what Dr. Todd might have accomplished, had his life been spared a 
few years longer. The collection has been purchased by the College of 
Surgeons, to add to the Hunteriaa Museum. 



PREFACE. IX 

lids, and the care with which I have indicated the nature of the 
diseases benefited by them, that I have gone far to correct many 
of the erroneous opinions which have hitherto existed on these 
subjects. However this may be, I do at least anticipate this good 
effect from my labours — that, for the future, those patients only 
will be sent abroad whose cases afford a reasonable prospect of 
benefit from such a measure ; and, that the practice of hurrying 
out of their own country a class of invalids, whose sufferings can 
only be thereby increased, and their lives shortened, will no longer 
be sanctioned, but that such persons may be allowed, henceforth, 
to die in peace in the bosom of their own families. 

As I anticipated that the following work would be perused by 
many persons not of the profession, but who are yet deeply inte- 
rested in the subject of climate, in relation to its effects on disease, 
I have endeavoured to express myself in as plain language as pos- 
sible; and I trust T have succeeded in making myself intelligible 
to the generality of readers, without at all diminishing the utility 
of my book to the members of my own profession. It has been my 
wish to lay before the public such a work as might serve at once 
as a manual to the physician, in selecting a proper climate for his 
patient, and a guide to the latter while no longer under the direc- 
tion of his medical adviser. It is only those who have resided 
abroad, and have mixed much with that numerous class of our 
countrymen who travel for health, that can know how very much 
such a publication is wanted ; and I may perhaps be permitted to 
add, at the same time, that it is only those who have attempted to 
compose such a work that can be aware of the difficulties of the 
task. 

London, May 22, 1829. 




V 2813 

THE S 

INFLUENCE OF CLIMATE, 

&C. &C. 



INTRODUCTION. 

The influence of climate over disease has been long established 
as a matter of fact, and physicians have, from a very early period, 
considered change of climate and change of air as remedial agents 
of great efficacy. This opinion is supported both by reason and 
experience : — it is reasonable, for example, to believe, that a change 
of residence from a crowded city to the open country, or from a 
cold exposed part of the country to a warmer and more sheltered 
situation — from a confined, humid valley, to a dry elevated district, 
or the reverse, would produce very sensible effects on the living 
body ; and we find by daily experience that such is the case. The 
marked improvement of the general health, effected by the transi- 
tion from the city to the country, even for a short period, is matter 
of daily remark \ and the suspension, or even cure, of various dis- 
eases by a removal from one part of the country to another, is an 
occurrence that must have come within the observation of every 
one. It may suffice to mention here, in reference to this fact, in- 
termittent fevers, asthma, catarrhal affections, hooping cough, dys- 
pepsia, and various nervous disorders. These diseases are often 
benefited, and not unfrequently cured, by simple change of situa- 
tion, after having long resisted medical treatment ; or they are 
found to yield, under the influence of such a change, to remedies 
which previously made little or no impression upon them. 

If such marked effects result from a change of so limited a nature 
as has just been noticed, it might be expected that a complete 
change of climate, together with the circumstances necessarily 
connected with it, should produce still more important results in 
the improvement of the general health, and in the alleviation and 
cure of disease. In this expectation we are also borne out by ex- 
perience. 

Unfortunately, however, for the character of climate as a remedy, 
it has too often been resorted to, either as a last resource, or it has 
been misapplied in cases wherein it would otherwise have been 



12 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

capable of yielding essential service. Patients, who really might 
have derived much benefit from change of climate, have too often 
been sent abroad without proper directions regarding the situation 
most suited to their complaints, and altogether uninstructed re- 
specting various circumstances, a due attention to which is neces- 
sary to give full effect to the best selected climate. 

Under such circumstances, it need not excite surprise that suc- 
cess has not more generally attended the practice of sending inva- 
lids abroad ; nor even, that the result should have been such as to 
bring the remedy into discredit. The fault, however, is to be sought 
for, not in the remedy, but in the manner in which it has been ap- 
plied. My own experience has been sufficient to satisfy me, that, 
for the prevention and cure of a numerous class of chronic diseases, 
we possess in change of climate, and even in the more limited mea- 
sure of change of air in the same climate, one of our most efficient 
remedial agents ; and one, too, for which, in many cases, we have 
no adequate substitute. 

On the Continent, the beneficial effects of change of air are duly 
estimated ; and the inhabitants of this country, and more especially 
of this metropolis, are now becoming fully sensible of its value. 
The vast increase in the size of our watering places, of late years, 
and the deserted state of a great part of London during several 
months, are sufficient proofs, not to mention others, of the increas- 
ing conviction that, for the preservation of health, it is necessary 
to change, from time to time, the relaxing, I may say deteriorating 
air of a large city, for the more pure and invigorating air of the 
country. This, indeed, is the best, if not the only cure, for that 
destructive malady, which may be justly termed cachexia londi- 
nensis, which preys upon the vitals, and stamps its hues upon the 
countenance of almost every permanent resident in this great city. 
When the extent of benefit which may be derived from occasional 
change of air both to the physical and moral constitution, is duly 
estimated, no person whose circumstances permit will neglect to 
avail himself of it. 

But to be beneficial, the remedy, simple as it appears, must be 
employed with judgment and discrimination. In that numerous 
class of persons, indeed, who are merely suffering from a residence 
in the city, without any decided disease, the mere change to the 
country may be all that is requisite to restore their health ; it is 
therefore of less consequence to what part they go. But the case is 
very different with the invalid whose sufferings are chiefly refer- 
able to some particular disease. To him, the selection of his tem- 
porary residence is not a matter of indifference. For one indi- 
vidual of this kind, an elevated situation and a dry bracing air, will 
be most proper ; a sheltered residence, with a milder air, will be 
suitable to another: while the sea-side may be the situation indi- 
cated for a third. In like manner it is with the more important 
measure of change of climate. The valetudinarian whose health 
is deteriorated by severe study or too close application to business, 



INTRODUCTION. 13 

and to whom relaxation of mind is as requisite as change of climate, 
may generally be permitted to choose the situation most agreeable 
to himself. But the great difference which exists in the physical 
characters of the climate of the places frequented by invalids in the 
South of Europe, and even in the southern parts — whether interior 
or sea-coast — of our own island, renders the selection of a winter 
residence a matter of vital importance to the invalid suffering un- 
der formal disease. 

This is a subject which has been but little attended to ; and the 
neglect of it has, I believe, arisen in a great measure, from the 
opinion which has generally prevailed in this country, that the 
beneficial effects of climate are evinced chiefly in consumptive dis- 
eases. Such an opinion could have originated only in a very 
limited acquaintance with the influence of climate on disease ; and 
is, indeed, so far from being a correct view of the matter, that, were 
the character of this remedy to be estimated by its effects on con- 
sumption, it would be justly valued at a very low rate. In dys- 
pepsia, and disorders of the digestive organs generally, and in the 
nervous affections and distressing mental feelings which so often 
accompany these ; in asthma, in bronchial diseases, in scrofula, 
and in rheumatism, the beneficial effects of climate are far more 
strongly evinced than they are in consumption. In cases also of 
general delicacy of constitution and derangement of the system in 
childhood and in youth, which cannot be strictly classed under any 
of these diseases ; and in that disordered state of the general health 
which so often occurs at a certain period of more advanced life, 
climacteric disease, in which the powers of the constitution, both 
mental and bodily, fail, and the system lapses into a state of prema- 
ture decay, change of climate becomes a valuable remedial agent. 

The undue confidence in the powers of climate as a remedy in 
consumption, which has so long prevailed in this country, is now 
in danger of giving place to the opposite and equally erroneous ex- 
treme of total distrust. This is, chiefly, in consequence of the sta- 
tistical reports on the health of our troops in almost all quarters of 
the globe, showing that there is no immunity from this disease in 
any climate. 1 

It is to be remarked, however, that, when an invalid is sent 
abroad for his health, he goes, by the direction of his physician, to 
the climate best suited to his particular case, and at the most favour- 

1 These reports, which have been so admirably drawn up by Mr. Mar- 
shall, Deputy Inspector-General of Hospitals, Major Tulloch, and Dr. Bal- 
four, are invaluable, and do infinite credit to the judgment and discrimina- 
tion of Lord Howick, late Secretary at War, who first duly appreciated their 
importance to medical science, and to Sir James M'Grigor, who, with the 
able assistance of Dr. Theodore Gordon, planned the annual reports and 
topographical statements on which the Statistical Reports are founded. 
These annual reports, which are highly creditable to the medical officers of 
the army, were first projected by Sir James M'Grigor, on his being placed 
at the head of the medical-department in 1815, and have been kept up on an 
uniform plan since 1816. 



14 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

able season of the year. Moreover, he goes prepared to avail him- 
self of all the advantages of his new situation, and to avoid, as far 
as possible, its disadvantages. Hence, the influence of any climate 
upon such an invalid, must be estimated very differently from the 
influence of the same climate on the permanent inhabitants, or on 
our troops who are resident in it at all seasons, and are exposed to 
all its prejudicial influences for years, as well as to many other 
causes calculated to injure health. 

The great lesson which the Army Medical Reports teach, in re- 
gard to consumption, is this: that, as it is a prevalent and fatal 
disease in all climates, and among all nations, our attention should 
be chiefly directed, not to a state of disease which is incurable by 
climate or any other means, but to the prevention and cure of the 
disordered state of health, which constitutes the real cause of con- 
sumption. It cannot be too strongly impressed upon the public, 
that until pulmonary consumption is viewed as a secondary dis- 
ease, originating in a morbid state of the whole system, we shall 
make little progress in diminishing the rate of mortality from it, or 
improving the public health. 

I have thought it right to make these remarks to show that I 
have not overlooked the result of the observations of the army 
medical officers. They contain much valuable matter on the 
geography of disease, and on the causes of sickness and mortality 
among our troops in different climates ; and there can be no doubt 
they will lead to the adoption of measures for preserving and im- 
proving the health of the army. But as regards the influence of 
change of climate in the prevention and even cure of disease, the 
information contained in these reports does not diminish our hopes 
of benefit from a temporary change of climate, or even from a more 
permanent residence, when the climate suited to the individual 
case is selected, and all other necessary precautions adopted. When 
change of climate is judiciously employed as a remedy for the con- 
stitutional disorder which precedes consumption, there will no 
longer remain any doubts of its beneficial influence ; and what a 
single change of climate does not effect, a succession of such 
changes will often be found to accomplish. 

Traveling. — The mere act of traveling over a considerable 
extent of country is itself a remedy of great value, and, when judi- 
ciously conducted, will materially assist the beneficial action of cli- 
mate. A journey may indeed be regarded as a continuous change 
of climate, as well as of scene ; and constitutes a remedy of une- 
qualed power in some of those morbid states of the system in which 
the mind suffers as well as the body. In chronic irritation and 
passive congestion of the mucous surfaces of the pulmonary and 
digestive organs, especially when complicated with a morbidly 
sensitive state of the nervous system, traveling will often effect 
more than any other remedy with which we are acquainted. 

But neither traveling nor climate, nor their combined influence, 
will produce much permanent benefit, unless directed with due 



INTRODUCTION. 15 

regard to the nature of the case, and aided by proper regimen. 
And here I would comment upon the error of expecting too much 
from the mere change of climate : — The air, or climate, is often 
regarded by patients as possessing some specific quality, by virtue 
of which it directly cures the disease. This erroneous view of the 
matter not unfrequently proves the bane of the invalid, by leading 
him, in the fulness of his confidence in climate, to neglect other 
circumstances, an attention to which may be more essential to his 
recovery than that in which all his hopes are centred. 

A residence in a mild climate will, no doubt, often do much. 
Among other advantages, for example, it will enable the invalid to 
be much in the open air during a part of the year when, were he 
in this country, he would be either confined to the house, or ex- 
posed to an atmosphere more likely to increase than mitigate his 
complaints. The exercise enjoyed in a temperate atmosphere, 
while it improves the general health, relieves the affected organs, 
by promoting and maintaining a more free and equable circulation 
in the surface and extremities ; and the constitution thus improved, 
may be enabled to overcome a disease under which it might have 
sunk in less favourable circumstances. The new scenes and the 
objects of interest, with which the South of Europe, more espe- 
cially Italy, abounds, exert a direct and beneficial influence also on 
the mental constitution ; and this influence will, in many cases, be 
greatly assisted, in an indirect manner, by the necessary abstrac- 
tion of the invalid from many causes of care and anxiety — in other 
words, from many sources of disease, to which he would have been 
exposed at home. 

These are some of the more obvious advantages which the in- 
valid may expect to derive from a residence in a foreign climate ; 
and they are assuredly great : but if he would reap the full mea- 
sure of good which his new position places within his reach, he 
must trust more to himself and to his own conduct, than to the 
simple influence of any climate, however genial : he must adhere 
strictly to such a mode of living as his case requires ; he must avail 
himself of all the advantages which the climate possesses, and 
eschew those disadvantages from which no climate or situation is 
exempt ; moreover, he must exercise both resolution and patience 
in prosecuting all this to a successful issue. 

In the body of the work, I shall have many opportunities of 
pointing out how the various circumstances, connected with change 
of climate, operate in the renovation of constitutions broken down 
by the long continuance of chronic diseases. At present I wish 
rather to impress the mind of the invalid with the danger of trust- 
ing too much to climate. Here, as in every other department of 
the healing art, we must be guided by experience : and must rest 
satisfied with the amount of power which the remedy concedes to 
us. The charlatan may boast of a specific for many or for all dis- 
eases ; the man of science knows that there exists scarcely a single 
remedy for any disease which can warrant such a boast ; and that 



16 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

it is only by- acting 1 on, and through the numerous and compli- 
cated functions of the living body, in various ways and by various 
means, and by carefully adapting our agents to the circumstances 
of each individual case, that we can check or remove the disorders 
of the animal system, more especially those which have long ex- 
isted. Let it not then be imagined that change of climate, how- 
ever powerful as a remedy, can be considered as at all peculiar in 
its mode of action, or as justifying, on the part either of the physi- 
cian or patient, the neglect of those precautions which are requi- 
site to ensure the proper action of other remedies. Had I not 
considered climate a remedial agent of great value, and deserving 
the utmost attention of medical men, the present work would not 
have been undertaken ; but I should feel that I were at once com- 
promising the dignity and honour of my profession, and acting in 
direct opposition to the dictates of experience, if I admitted for a 
moment, that it is one possessing specific powers, or which may be 
indiscriminately employed, without regard to the general and fun- 
damental principles of medical science. 

The importance which I attach to these considerations, and the 
conviction that they are not sufficiently attended to in the applica- 
tion of climate as a remedial agent, has induced me to reverse the 
order of my subject in the present edition, and to notice the dis- 
eases benefited by change of climate, before describing the different 
climates themselves. 



PART THE FIRST. 



ON DISEASES. 



DISORDERS OF THE DIGESTIVE ORGANS. 

The prevalence of disorders of the digestive organs and the great 
influence which they exercise over the other diseases treated of in 
this volume, claim for them the first consideration. On the present 
occasion, however, I do not think it necessary to enter so fully into 
the suhject as in the former editions of this work, seeing that it has 
been more attended to of late years. I shall therefore limit myself 
to the description of those features of dyspeptic disorder by which 
the selection of the climate adapted to each of its forms requires to 
be regulated. 

For my present purpose the morbid states of the digestive organs 
may be classed under three heads : — Inflammatory, or gastritic 
dyspepsia ; Irritable, or nervous dyspepsia ; and atonic dys- 
pepsia, or that form of the complaint which depends chiefly on a 
loss of tone. 

Although there are symptoms common to these different forms 
of dyspepsia, there are others peculiar to each, and by which they 
are characterised. 

In the gastritic, or inflammatory species, the tongue is redder 
than natural, especially towards the apex, where it is beset with 
small elevated points of a still brighter colour. It is also, for the 
most part, furred towards the base. In the morning on first awak- 
ing, it is dry, more particularly in cases where the irritation ex- 
tends to the duodenum and liver. The gums are red, swollen } and 
spongy, and bleed easily ; the mucous membrane of the throat is 
red, often dry and shining, and aphthous ulcers are apt to form on 
the tongue and inner surface of the mouth. The appetite is good, 
often craving. There is a disposition to thirst ; and pressure over 
the stomach generally gives uneasiness. The urine is high co- 
loured or turbid; the skin dry and sometimes affected with erup- 
tions, and the extremities, although occasionally cold, are often 
hot and dry, especially in the night ; whilst perspirations are not 
unfrequent towards morning. 

The eyes are injected, and the eyelids red and swollen. The 
pulse is contracted and quickened, more especially after meals, and 
1— b 2 dark 



18 CLARK ON THE SANATIVE INFLUENCE OP CLIMATE. 

towards night, except in languid constitutions, in which it remains 
slow. There is frequently a disposition to sleep during the day, 
and at night the sleep is uncertain ; the fc early part of the night 
being often passed in watchfulness, whilst in the morning there is a 
heavy slumber, followed on awaking by oppression and weariness, 
in place of the refreshment which succeeds to natural rest. Head- 
ach is not an uncommon symptom ; the pain is generally seated in 
the forehead, and the sensation is that of tightness and oppression 
rather than acute pain. It is most common in the evening and 
during digestion ; and that more certainly after an exciting meal. 
The patient is apt to be irritable, querulous, and despondent ; and 
there is little inclination to mental exertion, or power in concen- 
trating the mind on any subject. The influence of an irritated 
state of the digestive organs over the mental as well as bodily 
powers, I may remark in passing, is far greater than is generally 
believed. In childhood, the irritability of temper with which it is 
accompanied is very remarkable ; when the disorder is protracted, 
it is also a frequent cause of dulness in children, rendering them 
incapable of mental application. At a later period of life, the dis- 
position is often so thoroughly changed, the mind rendered so in- 
capable of exertion, and the memory so much impaired by long 
continued irritation of the digestive organs, that the sufferer 
becomes unable to apply himself steadily to any thing, and is inca- 
pacitated for his usual avocations, or even the ordinary intercourse 
of social life. 

Atonic dyspepsia. — In atonic dyspepsia the symptoms indicate 
a loss of tone in the digestive organs. There is little or no appe- 
tite, often a loathing of food, and even sometimes nausea. After 
eating there is a sense of distention or of oppression in the stomach, 
accompanied by a feeling of general uneasiness or listlessness, and 
a disposition to chilliness ; some time after the meal there are eruc- 
tations, heartburn, and other symptoms of laborious digestion. The 
tongue is pale and flaccid, not much furred, and seldom or never 
dry. There is not much thirst except during digestion. The 
urine is pale and abundant, and the bowels constipated. The pulse 
is weaker and sometimes slower than natural. The surface and 
extremities easily become cold ; the countenance is pale and the 
expression dull and heavy; there are inaptitude and inability for 
bodily exertion, and a corresponding languor of mind. 

These symptoms vary in intensity at different times. In bright 
dry weather, or under circumstances of pleasurable mental emotion, 
the appetite is better and the digestion is performed without the 
usual feeling of distress. On the other hand, in damp, cloudy 
weather, or under feelings of mental depression, all the symptoms 
are greatly aggravated and others superadded. Epigastric pain, 
great distention, fetid eructations, vomiting, headach, vertigo, faint- 
ness, cold clammy perspirations and cramps are liable to supervene, 
if much food, or food of an indigestible quality, has been eaten. In 
such a state of stomach, faintness, amounting to syncope, may 



DISORDERS OF THE DIGESTIVE ORGANS. 19 

occur after a heavy or indigestible meal, more especially after long 
fasting. 

This form of dyspepsia occurs most frequently in languid leuco- 
phlegmatic temperaments, and in cold humid weather and situa- 
tions. 

Nervous dyspepsia. — In nervous or irritable dyspepsia, the 
tongue deviates less from the natural state ; it is pale, and often 
covered with a thin white fur ; in some cases it is swollen, and 
exhibits the impressions of the teeth along its margins, especially 
in the morning ; it is rarely dry, and there is little thirst. The 
appetite is unsteady, sometimes craving, and at other times quite 
wanting, especially for breakfast. Flatulency is a prominent symp- 
tom. The urine is pale and often very copious; the bowels, 
though constipated in some cases, are more frequently in an oppo- 
site state, and this is especially the case when the nervous system 
is peculiarly sensitive. 

The sleep is .uncertain, easily interrupted, and often unrefresh- 
ing. The pulse is small and quick, but less steady in its character 
than in gastritic or in atonic dyspepsia. The skin is cool, and often 
damp and clammy. Headach is a prominent and often very dis- 
tressing symptom in this form of dyspepsia. The morning is the 
most frequent period of its attack, being felt on awaking ; and at 
all times it is more liable to occur when the stomach is empty than 
during the process of digestion : hence long fasting proves a fre- 
quent exciting cause ; over fatigue, articles of food which irritate 
rather than excite the stomach, such as sweet subacid substances, 
pastry, dry fruits, and imperfectly masticated food ; strong mental 
impressions, and the air of crowded rooms, are also frequent ex- 
citing causes. The headach, when occurring during the day, is 
sometimes sudden, but in the severer attacks is generally preceded 
by a sense of coldness and creeping on the surface, which may 
amount to shivering. In some cases the attack is preceded by 
numbness in the extremities, by dimness of sight, or ocular spectra ; 
in others, a peculiar uneasy sensation, originating in one of the ex- 
tremities, ascends gradually to the head, resembling the aura epi- 
leptica. Nausea or vomiting occasionally occurs at this stage, and 
the pulse is mostly slower than natural. In the commencement, 
there is a sensation of uneasiness rather than of actual pain ; but 
as the feeling of coldness diminishes, the true headach becomes 
developed. The pain is then intense and throbbing, affecting one 
side in general more than the other ; and in the cases in which it 
has been of the most agonising kind has been confined to a small 
spot over one eyebrow or temple. The upper and back part of the 
head is often the seat of pain, and the latter place is particularly apt 
to be so, when the headach is partly dependent on uterine irrita- 
tion or congestion. The pain, wherever seated, is greatly aggra- 
vated by mental excitement or bodily exertion. This class of 
headachs is common, in delicate nervous persons, particularly 
females, when its immediate dependence on dyspepsia is often 

2* 



20 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

overlooked, but very generally the connection is discovered upon 
minute inquiry into the circumstances of the case. 

The temper is apt to be fretful, and the mind anxious and de- 
sponding, particularly regarding the health. 

Independently of the particular symptoms belonging to each 
form of dyspepsia, there are circumstances in their general cha- 
racter which distinguish them. The symptoms which accompany 
gastritic dyspepsia, are more fixed and permanent; they maybe 
present in a greater or less degree, according to circumstances, but 
they are scarcely ever absent. In nervous dyspepsia, on the con- 
trary, the symptoms vary in a remarkable manner. The patient 
feels, at times, almost entirely free from them, and the functions of 
the digestive organs are performed with scarcely any indication of 
derangement ; at other times all the symptoms are greatly aug- 
mented, the patient being unable to assign any cause for their dis- 
appearance, in the one case, or their increase in the other. Atonic 
dyspepsia resembles more in its characters the nervous dyspepsia 
with which it is often complicated. Both forms are greatly influ- 
enced by mental emotions, changes of the weather, and other 
causes which particularly affect the nervous system. The symp- 
toms which characterise the gastritic form of the disease, are in- 
creased by stimulants of every kind taken into the stomach, whereas 
the same means often afford temporary relief in the other two 
forms. 

In mixed cases, these distinguishing characters may be observed 
more or less as the one or other form of dyspepsia prevails. When 
the gastritic and nervous dyspepsia exist together we have both 
inflammatory excitement and extreme morbid sensibility — the one 
or other state predominating at different times. This form of the 
disease occurs chiefly in persons of a nervous temperament, to 
whom the causes of gastritic dyspepsia have been applied. In like 
manner, nervous is often associated with atonic dyspepsia ; — a mor- 
bidly sensitive state of the stomach with loss of tone, a condition 
the converse of inflammation. Yet, in all these mixed cases, the 
distinctive characters of the prevailing affection may generally be 
recognised. 

But in protracted cases the disorder is seldom confined to the 
stomach; it is gradually propagated to other portions of the diges- 
tive tube, and the secreting organs in connection with it; more 
especially to the duodenum and liver. In many cases, indeed, the 
disease is chiefly seated in the duodenum, constituting what has 
been denominated duodenal dyspepsia, a very important form of 
dyspeptic complaint, to which I shall have occasion to recur, when 
noticing the diseases of children, under the head of strumous or 
scrofulous dyspepsia, or that form which is most frequently ob- 
served in children of a scrofulous constitution. 

We also find that the morbid state of the digestive organs, in 
place of being propagated along the mucous surfaces, extends its 
influence to other systems. Thus we find it giving rise to various 



DISORDERS OF THE DIGESTIVE ORGANS. 21 

affections of the skin, of the joints, and of the nervous system. 
Among the last may be mentioned, in addition to headachs, con- 
vulsive affections, tic douloureux, paralysis, amaurosis, deafness, 
loss of smell, loss of voice, spasmodic cough, asthma, palpitation, &c. 

The nature of the secondary affection depends, often, upon pecu- 
liarities of constitution ; but frequently, also, upon accidental 
causes, exciting or disposing to particular diseases during the ex- 
istence of dyspepsia. The new disease being engrafted on the old, 
becomes as it were dependent on it, and the former cannot be cured 
till the latter is removed. The secondary disease being established, 
the primary affection is often mitigated, at least for a time. Indeed, 
so remarkably is this the case, that the primary disease is frequently 
overlooked, both by the patient and his medical attendant, amid the 
more prominent symptoms of the secondary affection. This I 
found frequently the case in patients sent abroad labouring under 
chronic bronchial and tracheal irritation, symptomatic of gastritic 
and duodenal dyspepsia. 

Among the remedial measures for these various morbid condi- 
tions of the digestive organs, and the sympathetic diseases which 
originate in them, change of climate is one of the most efficient. 
Even when the patient cannot avail himself of a more complete 
change of climate, he may still derive much benefit from a tempo- 
rary residence in some of the milder situations in our own island. 

In recommending such a change, however, to the dyspeptic in- 
valid, the peculiar disorder of the stomach must be attended to. 
The different forms of tke disease, noticed above, require differ^ 
climates. The patient with gastritic dyspepsia should not, fn' ex- 
ample, go to Nice, nor the southeast of France. In cas^ °f ttils 
kind, the southwest of France or Devonshire are pre^ raD ^ e j an d 
Rome and Pisa are the best places in Italy. On the jtner naiJ d, in 
atonic dyspepsia, in which languor and sluggish^ ss °f tne system, 
as well as of the digestive organs, prevail, w An lowness of spirits 
and hypochondriasis, Nice is to be preferred t0 a ^ tne other places 
mentioned; and Naples will generally *gree better than Rome or 
Pisa; while the southwest of France and Devonshire, and all 
similar climates, would be injurious. In the nervous form of dys- 
pepsia a climate of a medium character is the best, and the choice 
should be regulated according as there is a disposition to the gas- 
tritic or the atonic form. 

In the more complicated and protracted cases, still more dis- 
crimination is required in selecting- the best climate and residence ; 
as we must take into consideration not merely the character of the 
primary disorder, and the state of mind with which it is associated, 
but the" nature of tho secondary affection which may already exist, 
or to which the patient may be predisposed. 

To insure the full advantages to be derived from the best se- 
lected climate, urgent symptoms should be removed or alleviated 
before the patient commences his journey ; and he should, more- 
over, have the nature of his disorder, and the principles upon which 



22 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

he should regulate himself while traveling, and during his residence 
abroad, fully explained to him. Indeed, the want of attention to 
these things is one of the chief reasons why so many dyspeptic in- 
valids derive little permanent advantage from their summer tour, 
or even from a more prolonged residence abroad. In order to secure 
success from change of air or climate, it is necessary that the pa- 
tient should understand the conditions on which the promise of 
advantage is made, and how they are to be best and most perfectly 
fulfilled. Above all, it should be impressed on his mind, that he is 
not to expect too much from climate ; that he must sedulously 
avoid the causes which brought on the disease, and adhere with 
steadiness to such a general regimen as is necessary for its removal. 
Aided by this moral and medical discipline, a winter spent in a 
favourable climate cannot fail to prove highly beneficial to the dys- 
peptic invalid ; and a well directed course of mineral waters, the 
following summer, will, in manycases ; be of the greatest service in 
restoring the impeded functions of the abdominal viscera and of the 
skin. After this, the patient may enjoy a degree of bodily health, 
and of mental energy, to which he has long been a stranger; and 
may continue to reap the fruits of. his perseverance and self-denial, 
so long as he shall avoid the exciting causes of the disease. 

The extent to which change of air or climate requires to be car- 
ried, for the removal of stomach complaints, will depend on the 
circumstances of the case. In -many instances a few months, even 
a few weeks, judiciously employed, will do much for the restoration 
^ the health; in others, a much longer* period will be required. 
In ^-eating, therefore, of the influence of change of climate and 
change of air in dyspeptic disorders, it will be both convenient and 
useful to Gf.vide them into two classes — the more recent and simple, 
and the more r> rC )t rac ted and complicated cases. 

Of the more * e cent and simple cases of Dyspepsia. — Under 
this class of dyspeptic patients is comprehended that numerous 
body of our citizens, a»d the inhabitants of large towns generally, 
whose health, and digestif organs in particular, have suffered by 
a sedentary life, close application to business, errors in regimen, &c. 
during the winter, and who inquire change of air during the 
summer. 

The plans generally adopted with this view, are a visit to some 
of our watering places, or a tour through ih e mountainous parts of 
our own island, or on the Continent,— and more particularlv in 
Switzerland. The preference which one or the other of these mea- 
sures may deserve, will depend upon the nature of the case, the 
convenience of the patient, and various other circumstances, which 
can be appreciated only by the patient himself, and his physician. 

We shall suppose that a tour is the measure adopted. Having 
had the more urgent symptoms of his complaint removed or alle- 
viated, before he sets out,' the next object of importance with the 

1 See Introductory Remarks to Part Second. 



DISORDERS OF THE DIGESTIVE ORGANS. 23 

dyspeptic traveller is diet. This must be regulated according to 
the state of the digestive organs, regard being had to the exciting 
effects of traveling, which render more especial attention to the diet 
necessary during a journey. If much gastric irritation exists, and, 
more espicially, if this is accompanied with any disposition to fever, 
the diet should be very mild and moderate in quantity. A small 
proportion of animal food, once a-day, is all that should be allowed 
in such cases. Tea or arrow-root, or sago, forms the best evening 
meal. The best general drink is toast-water; wine, and all kinds 
of fermented liquors and spirits, should be avoided by the greater 
number of dyspeptic patients during a journey. 

I am aware that in traveling on the Continent, it is not always 
an easy matter to obtain that kind of food which is suitable to 
irritable or delicate stomachs ; but a little management on the part 
of the traveller will generally suffice to obviate this difficulty. The 
soups of the Continent, if not so strong, are generally more whole- 
some, and agree better with irritable stomachs than the rich exciting 
soups used in this country. The opinions commonly entertained 
respecting soup in dyspeptic affections, are not applicable to every 
form of dyspepsia, nor to all soups. 

Fruit should generally be abstained from, as it will seldom be 
found to agree in any form of stomach complaint. An exception is 
to be made in favour of good ripe grapes, which are often useful in 
gastritic dyspepsia. Ripe grapes, eaten in considerable quantity for 
several weeks together, is a remedy (cure de raisins,) employed on 
the Continent in several complaints. In the inflammatory form of 
dyspepsia, more especially when there exists a similar state of the 
mucous membrane of the intestines, with a disposition to diarrhoea ; 
also in chronic cases of this disease, and in hemorrhoidal affec- 
tions, ripe grapes are considered of great use. 

If the dyspeptic invalid will observe the effects which the differ- 
ent articles of food produce, and be true to himself and candid in 
his observations, he will soon discover that the more moderately he 
lives the better he will feel. When he has passed a restless night, 
or has a dry or loaded tongue, or bitter taste in the morning, he 
may be assured, that the regimen of the preceding day was not 
suited to him, that he has erred either in the quantity or quality of 
his food, and should regulate himself accordingly for the future. 

The next circumstance requiring the particular attention of the 
dyspeptic traveller, is the state of the bowels. Constipation is an 
evil from which travellers generally, and more especially dyspeptics, 
suffer ; and it is of great consequence that this state should be ob- 
viated. The mild diet which has been recommended will be a 
means of favouring the action of the bowels, and of moderating the 
injurious effects of their inaction when this occurs. For the removal 
of constipation, the milder laxatives are much safer, and more effec- 
tual than drastic purgatives. The latter, even when given in the 
smallest doses, irritate the stomach and bowels, and, in this way, 
are often productive of more mischief than the state they are in- 



24 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

tended to obviate, which state their frequent repetition tends, more- 
over, to confirm. Castor oil, or confection of senna, or manna, 
taken in such doses only as are sufficient to obviate constipation, 
are the best medicines. They may be taken at bed-time, so as to 
act the following: morning. When the stomach cannot bear these 
medicines, a mild aperient pill may be occasionally given. But 
what often answers much better than any aperient medicine, is the 
use of mild lavements. To persons who have very sensitive bow- 
els, and who suffer from constipation, this proves an invaluable 
remedy, more especially during a journey ; and no one should tra- 
vel without being provided with the means of relieving the bowels 
in this way. The relief obtained by the judicious use of this 
remedy, will not only add greatly to the comfort of the patient, but 
favour the return of the bowels to a more healthy and regular per- 
formance of their functions: while it will obviate the necessity of 
having frequent recourse to purgative medicines, a fruitful source 
of mischief, as I have already remarked, to dyspeptic invalids. The 
lavements should consist of water, barley-water, oatmeal-water, or 
thin gruel, tepid, or, what answers better in many cases, an infusion 
of chamomile flowers. Cold water proves very beneficial in some 
cases; but soap and more irritating substances are generally objec- 
tionable. The quantity injected need not be great ; half a pint, or 
even less, will often bring on an action of the bowels more readily 
than a larger quantity. 

Tepid bathing is a remedy that should never be neglected by the 
dyspeptic invalid while traveling. Independently of its utility as a 
means of cleanliness and comfort, it promotes the cutaneous exhala- 
tion, tends to equalise the circulation, and cools and soothes the 
whole system. 

If the dyspeptic invalid will attend to these simple directions, he 
may derive much and lasting: benefit from his tour. He should 
keep in mind that he has an important object in view; that health 
is only to be regained by such a mode of traveling as is compatible 
with his strength, and by strict adherence to such a regimen as. 
comports with the deranged state of his digestive organs. 

These observations, which are intended chiefly for travellers on 
the Continent, are equally applicable to those who confine them- 
selves to excursions in our own island, or passing some time at the 
sea-side, or inland watering-places, during the summer. Those 
who visit the sea-coast will find the tepid sea-bath a most valuable 
remedy. With a few dyspeptics cold sea-bathing may as;ree, but 
does not suit the majority of cases. The cold or tepid shower-bath 
is better, and will be found more generally beneficial. The warm 
or tepid bath is useful in almost every case. The vapour bath will 
prove serviceable in certain cases, more especially where the si 
has been long in a dry state ; but its indiscriminate use for the 
removal of this symptom, is calculated to do mischief. It should be 
impressed on the patients mind, that it is in vain to expect that any 
kind of bath or anv remedv. will restore the natural secretion of 



DISORDERS OF THE DIGESTIVE ORGANS. 25 

the skin, while the irritation of the digestive organs is kept up by- 
improper diet. The dry skin is consequent upon irritation of some 
internal organ ; and until this be removed the natural state of the 
surface cannot be restored. Without attention to this, the vapour 
bath will be of little use. and may prove injurious. 

The great and common errors in dyspeptic cases are, as I have 
already said, the condition in which invalids are sent abroad, and 
the manner in which they live while there. Much greater and 
more permanent benefit would be derived from a change of air, 
were its effects aided by such remedial measures and such a regi- 
men as the nature of the case requires. As these matters are gene- 
rally managed, the invalid has frequently not returned many 
weeks, when he finds himself in the same state nearly as when he 
left his home. The reason of this is sufficiently obvious. Previously 
to the tour, nothing effectual is done for the mitigation of the disor- 
der of the digestive organs, and no system of regimen is adopted, 
by which the beneficial effects of change of air and traveling may 
be favoured and rendered more permanent. All is trusted to air, 
relaxation from business, and amusement ; and when the influence 
of these is withdrawn, the dyspeptic and nervous invalid lapses 
rapidly into his former state. 

Of the more protracted and complicated cases of Dyspepsia. — 
Persons whose digestive organs have been long deranged, and 
whose consiitutions have suffered in consequence, will require, in 
order to obtain much or lasting benefit, a more prolonged residence 
in a mild climate. The impressions produced by causes operating 
for a series of years on the digestive organs, and. through them, on 
other important organs, and on the system generally, are not to be 
effaced by a residence of a few months in the best climate, even 
when assisted by the most judicious regimen, and the most exem- 
plary conduct on the part of the patient. 

Generally.speaking, such invalids will derive benefit by changing 
our damp, chilly climate, for a drier and milder one, during the 
winter. But it is not a matter of indifference in what place they 
fix their abode ; and, indeed, it was chiefly the consideration of this 
circumstance which induced me to go somewhat into detail, in 
endeavouring to describe the distinguishing characters of the differ- 
ent affections of the digestive organs. 

I have pointed out three forms of dyspeptic disorders : — one, in 
which there is an inflammatory state of the mucous surfaces of the 
digestive canal; another, in which an opposite condition prevails — 
a state of atony; and a third, in which a morbidly sensitive state of 
these organs is the principal feature, and which is also, for the most 
part accompanied with a languid condition of the digestive function. 
These are important distinctions, and must never be lost sight of in 
prescribing for dyspeptic patients, whether it be regimen or climate. 

It is true that these morbid states pass into each other in every 
variety of shade, from the pure inflammatory dyspepsia on the one 
hand to the pure atonic dyspepsia on the other ; and the successful 



26 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

management of each case will much depend upon the degree of 
discrimination exercised in referring it to its proper place in the 
scale. This applies as much to change of climate, as to any other 
remedy. 

The selection of a residence even in the same place is not a mat- 
ter of indifference to very sensitive invalids. One will feel himself 
better in an elevated situation, another in a lower and more shel- 
tered one. The high and low and more confined situations of 
Rome and of Naples, afforded me many opportunities of observing 
the different effects of locality on such persons, and satisfied me of 
the necessity of attending to this circumstance, in selecting a resi- 
dence for them. But dyspeptic patients, who pass the winter in 
Italy, need not in general be limited to one place. Although the 
climate most suited to the particular character of their complaint 
should be selected as their head-quarters, they may visit, during the 
season, the principal cities in the south of Italy; and if this is done 
with judgment, the successive changes may prove beneficial to their 
health. Generally speaking, Rome will be the best residence in 
Italy in gastritic dyspepsia, especially during the spring; Nice the 
best climate in the purer cases of atonic dyspepsia. 

To all these patients the spring proves the period of the greatest 
excitement ; and they who are disposed to the more acute kind of 
stomach affections, must be particularly on their guard against what- 
ever excites the digestive organs at this season. The same degree of 
stimulus that is tolerated in the winter, will prove injurious to them 
in the spring. In irritation of the mucous membranes, whether 
of the digestive or pulmonary organs, I had every year occasion to 
remark the increase of excitement that occurred during the spring 
months in Italy. At this season there are great and often rapid 
alternations of temperature, which are extremely exciting to sensi- 
tive invalids. A powerful sun, frequently accompanied with a 
sharp wind during the day, alternates with cold nights. This may 
be said to be the character of the spring every where; even within 
the tropics it prevails in some degree; but in the south of Europe 
it is particularly so, and this circumstance renders the climate 
injurious in the more acute degrees of gastritic dyspepsia. 

It is not, however, as I have already observed, for the acute 
forms of dyspepsia that I recommend a change of climate — but for 
affections of some standing, in which the more acute stage has 
passed over, and with it the highly excitable state of the digestive 
organs. For these, and for the essentially chronic cases of dys- 
pepsia, a residence for some time in the south of Europe, under the 
limitations already pointed out with respect to season, residence, 
regimen, <fcc, will be of the greatest service. For the hypochon- 
driac, more especially, whose mind is likely to feel an interest in the 
variety of scenes, and the objects of art which present themselves 
so abundantly in Italy, I know not any measure more likely to 
prove beneficial. I class the hypochondriacal with the dyspeptic 
patients: because, without venturing to affirm that hypochondriasis 



DISORDERS OF THE DIGESTIVE ORGANS. 27 

is always a consequence of dyspepsia, I think it may be safely 
asserted that the former is very rarely met with unaccompanied by 
more or less of the latter; and, in a large proportion of cases, both 
acknowledge the same origin, and are cured by the same means. 

Though patients of a hypochondriacal turn of mind should not 
be encouraged to dwell on their complaints, and attend to every 
trifling sensation, I consider it essentially wrong to send them 
abroad with the assurance that their complaints are purely imagi- 
nary, — that nothing is required but change of air, of scene, and 
amusement, to dispel their gloomy thoughts and restore their health. 
That there may be cases in which the physician can do little more 
for his patient than commit him thus to the wide world, I am not 
prepared to deny ; but I believe they are rare ; at least I did not 
meet with any such during a residence of many years on the Con- 
tinent, where my intercourse with patients of this class was pretty 
extensive. On the contrary, a single case did not fall under my 
observation, in which careful examination could not detect a de- 
ranged state in the functions, if not in the structure of some internal 
organ; and in which judicious medical treatment would not have 
promoted the beneficial influence of climate. When we are better 
acquainted with the morbid conditions of the digestive organs, and 
with the extensive influence which they exert on the mind, we shall 
have less frequent occasion to confess our ignorance of the patient's 
complaints, by attributing them to nervousness, to low spirits, or 
other imaginary states designated by the like unmeaning ex- 
pressions. 

With regard to the general management of these cases while the 
patient is traveling, — the same directions are applicable as to the 
more recent cases of dyspepsia, which have just been detailed. 

As on the journey, so during their residence abroad, the diet is 
the most important circumstance requiring the attention of dys- 
peptic invalids. Seeing that the stomach is the organ primarily 
and principally affected, it requires no argument to prove that, 
unless the diet be such as is suited to its morbid condition, climate, 
or any other means, will do little good. It is impossible, however, 
in this place, to do more than point out in a general way the kind 
of diet which T found most generally suited to this class of patients. 
I have already remarked, and it is a circumstance deserving the 
particular attention of invalids, that, in removing to a warmer cli- 
mate, the sensibility of the system is increased, and that conse- 
quently stimulants of every description more easily excite. Hence, 
the diet which may be proper in England, will not agree in Italy, 
nor in the south of France. This remark is especially applicable 
to persons suffering from stomach complaints. There is, no doubt, 
a difference in dyspeptic patients, as well as others, in this respect ; 
but I invariably found a mild and "very moderate diet the most suit- 
able for them; and for this plain reason, — that whatever may be 
the nature of the disorder of the stomach, debility, or, in other 



28 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

words, a diminution in the powers of the organ for the performance 
of its functions, is an almost constant accompaniment of the disease. 

Wine, when it is permitted, should always be taken in great 
moderation ; and it will be found that the lighter kinds, if not acid, 
generally agree the best. Of wines imported into Italy, those of 
Bourdeaux are to be preferred. The spirituous wines of Spain, 
Portugal, and Sicily, if used, should be largely diluted. Seltzer 
water will often prove a good substitHte for wine. 

It would be a wise rule for all dyspeptic patients to abstain 
entirely from every thing that is brought to table in the form of 
dessert. This advice I feel cannot be urged too strongly ; nor can 
the dyspeptic patient have too forcibly impressed upon his mind 
that temperance and abstemiousness are the best physic. The be- 
lief so generally entertained that medicine can counteract the effects 
of habitual errors in regimen, should be regarded as mere sophistry. 
There is but one road to a permanent cure in these cases, and he 
who shall steadily pursue it long enough to feel its advantages, in 
the restoration of mental and bodily energy, will not easily be 
induced to deviate from it again. 

Exercise in the open air is one of the greatest advantages wlrch 
a winter residence in the South affords; and the dyspeptic invalid 
should take full advantage of it. Walking and riding on horseback 
are the best kinds of exercise, but neither should be carried so far 
as to produce over-fatigue. When the irritation of the stomach is 
complicated with that of the bronchial membrane, riding should be 
chiefly relied on for exercise. Exercising the arms every morning 
is very useful in dyspeptic complaints; for this purpose the clubs 
so much used in. India are much to be preferred to dumb-bells. 
While on the subject of exercise, I must not omit to mention 
that on the water, which to many invalids is very soothing and 
beneficial. 

Friction of the whole surface of the body, night and morning, is 
a valuable remedy, and is especially suited to the sedentary, as be- 
ing the best substitute for exercise. For those whose occupation 
compels them to a sedentary life, in our damp and cold climate, 
there are few remedies more useful, though none more neglected, 
than friction. The diligent use" of this, and sponging the surface 
with cold or tepid vinegar and water, or the shower-bath daily, 
during summer, and the use of the warm bath at all seasons, regu- 
lated according to the constitution of the patient, form a powerful 
combination of means for maintaining the health of such persons as 
are constrained by circumstances to forego the natural modes of 
bodily exercise in the open air ; and the same measures are often 
singularly efficacious in restoring the diminished energy of the 
skin and digestive organs in cases of nervous and atonic dyspepsia. 
They should not, however, be considered as superseding exercise 
in the open air when at all practicable, For the want of exercise, 
nothing can fully compensate ; but the means which I have sug- 



DISORDERS OF THE DIGESTIVE ORGANS. 29 

gested will in some degree supply its place, and will always prove 
beneficial to the class of invalids for whom I am now writing. 1 

Cold and damp weather is particularly injurious in dyspepsia, 
more especially in the nervous and atonic forms, in which coldness 
of the surface and extremities, is a prominent symptom. The use 
of warm clothing, therefore, forms an essential part of the treatment 
in such cases. Flannel should be worn next the skin during the 
day; and when any change of dress is made, in the summer, it 
should be effected gradually and with great caution ; and the 
change of weather in autumn should always be anticipated by a 
return to warmer clothing. These precautions are equally neces- 
sary in a southern climate. 

All these measures tend directly to maintain a free circulation 
through the extremities and surface, — an object of the greatest im- 
portance in the treatment of dyspepsia. Indeed, I conceive that it 
is chiefly in consequence of the active circulation on the surface 
during the warmth of summer, and being more in the pure open 
air, that so many feeble, dyspeptic, and nervous invalids find them- 
selves better and get stouter during that season, and that the hypo- 
chondriac's mind is freed of half the gloom which oppressed it; 
whilst, on the contrary, it is from the diminished activity of the 
circulation in the surface and extremities, and the consequent con- 
gestion of the internal organs, and also from breathing so constantly 
the comparatively impure air of a room, that such patients languish 
during nine months of the year in this country. On this principle, 
much of the advantage derived from passing the winter in a mild 
climate may be explained. 

If the measures which I have just recommended be steadily 
adopted, little medicine will be required. It will at all times be 
necessary to attend to the state of the bowels ; though the dyspeptic 
invalid should endeavour to bring them to act regularly by proper 
regimen and exercise rather than by medicine. That this may 
generally be done, even in very obstinate cases of constipation, I 
am satisfied from experience ; and in young persons regularity of 
bowels may often be induced, in a much shorter period than could 
be believed. In this respect a change of climate often acts very 
beneficially. 

I once more beg that it may be clearly understood that I do not 
recommend traveling, or a residence in the south of Europe, to 
patients labouring under the more acute forms of gastritic dys- 
pepsia ; much less do I advise such a measure to those labouring 
under organic disease or chronic inflammation of any of the abdo- 
minal viscera. When organic changes have taken place, or inflam- 
mation is established in any organ of importance to life, a long 

'For the most judicious instructions on this subject, the reader is referred 
to Dr. Combe's work on the Principles of Physiology applied to the Pre- 
servation of Health, and to the Improvement of Physical and Mental 
Education, Eighth E'dition ;— a book which no family should be without. 



30 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

journey is more likely to increase than diminish the evil. When- 
ever inflammation exists in a degree sufficient to excite the circula- 
tion, in whatever organ or structure it may be situated, I consider 
rest an essential part of the treatment, although it is much neglected 
in chronic diseases. 

The nature of a disease should be well ascertained before the 
patient is urged to take active exercise, or is permitted to undertake 
a long journey. If the disease be of a purely nervous character, 
active exercise in the open air forms a most effectual means of 
restoring the health ; whereas, if the symptoms depend on chronic 
inflammation, the same measure will scarcely fail to increase it, and, 
as I have frequently had occasion to observe, may even convert a 
chronic into an acute disease. The distinction is, therefore, very 
important, but it is one which I have reason to know is not gene- 
rally attended to. 

After a winter passed in a mild climate, a judicious course of 
mineral waters will prove a very efficient remedy in cases of dys- 
peptic disease, dependent upon, or complicated with a congested 
state of the liver and other abdominal organs, and a disordered state 
of all the secretions. For my views on this subject, I must refer to 
the Appendix on Mineral Waters. 



PULMONARY CONSUMPTION. 

There is no subject connected with health, possessing greater 
claims to attention than that which relates to the class of diseases of 
which Pulmonary Consumption is one of the most frequent and 
fatal forms ; at the same time, there is perhaps none concerning 
which the public is less accurately informed. 

In the former editions of this work, I entered pretty fully into the 
causes, nature, and progress of Pulmonary Consumption ; but hiv- 
ing lately published a separate Treatise on the subject, I shall con- 
fine myself, on the present occasion, to a brief description of the 
constitutional disorder, Tuberculous Cachexy, which precedes 
consumption, and to a notice of the more evident indications by 
which a tuberculous state of the lungs may be recognised. 

Tuberculous Cachexy was employed, in the first edition of 
this work, to designate that morbid state of health which precedes, 
and in fact, constitutes the essential predisposing cause of pulmo- 
nary consumption. The term has been generally adopted by the 
profession, but the disorder itself has not yet received that degree 
of consideration which its importance demands. The attention is 
still too exclusively directed to the pulmonary disease, and too little 
notice taken of the constitutional affection ; although it is only on 
the proper treatment of the latter that we can rest our hopes of suc- 
cess, — all efforts to cure the former having been as yet compara- 
tively of little avail. It is of the utmost consequence, therefore, 



PULMONARY CONSUMPTION. 31 

that we should be able to distinguish the leading features by which 
the constitutional, or curable period of the disorder may be recog- 
nised. 

The aspect and general appearance of a young person labouring 
under tuberculous cachexy, are generally well marked. The 
countenance is pale, with a sallow cast, although it is in this respect 
subject to considerable variations. In persons naturally of a florid 
complexion the changes are often very remarkable : at one time 
general paleness, with a faded expression of countenance ; at an- 
other, an irregular mixture of white and red prevails ; but in place 
of the gradations by which these colours pass into each other in 
health, they terminate abruptly, giving the face a blotched or spotted 
appearance. Sallow complexions assume a peculiarly dull, leaden 
hue ; there is paleness or lividity of the lips ; the eyes have gene- 
rally a dull, pearly aspect; and the whole countenance commonly 
appears sunk and Languid. These indications, as I have already- 
said, are very variable, and may pass for many months unnoticed, 
except by the immediate relations or the physician ; but as the 
constitutional disorder increases they become evident to the most 
cursory observer. 

Upon close examination, the skin of such a patient will be found 
in an unhealthy condition : either harsh and dry, or moist, clammy, 
and relaxed. Its colour, too, is often changed to a sallow, and, in 
some cases, to a dirty yellowish hue ; and, except on the cheeks, 
there is always a deficiency of red vessels. In some hereditary 
cases, particularly in females of a fair and delicate complexion, the 
skin has a semi-transparent appearance, resembling wax-work, and 
the veins may be seen distinctly through it. The temperature, 
also, of the surface and extremities is below the standard of health. 
The digestive organs are very generally deranged, though the 
degree and nature of the derangement differ materially in different 
cases. The tongue is more or less furred ; the point and margin 
are redder than natural, and often studded with enlarged fungiform 
papillae of a still brighter hue. In a class of cases, of much rarer 
occurrence, the tongue is clean and natural in its appearance, and 
the mucous membrane of the internal fauces pale. I have remarked 
this chiefly in females, in whom the disease has been owing to 
hereditary predisposition, and little complicated with gastric disor- 
der. But in by far the greater proportion- of cases, the functions of 
the digestive organs are more or less deranged. 

The nervous system also partakes of the general disorder. There 
is more nervous sensibility than is natural to the patient. The 
sleep is not sound; being disturbed or unnaturally heavy, and 
rarely refreshing. In the purer and less complicated cases of here- 
ditary consumption, there is generally great serenity of mind ; the 
spirits are of surprising buoyancy ; and the hope of recovery 
remains to the last. But this state of mind is a less constant atten- 
dant on consumption than is generally believed ; especially when 
it has been preceded by long continued disorder of the digestive 



32 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

organs. In such cases there is oftentimes great impatience, and 
irritability of temper. 

The state of the circulation is subject to great variety. In here- 
ditary cases, the power of the heart is commonly under the ordi- 
nary standard, whilst the frequency of the pulse is generally above 
it, and palpitation is a frequent symptom. The circulation is in 
general feebly carried on through the extreme vessels, as is shown 
by the condition of the skin already noticed, and the tendency to 
coldness of the extremities. This state of the surface and extremi- 
ties is a very constant attendant on abdominal congestion, compli- 
cated with an irritated condition of the gastro-intestinal mucous 
surfaces; and hence it is generally more evident, according as the 
disorder of the digestive organs is more considerable. 

Although, in the great majority of cases, the indications of dis- 
ease just enumerated are sufficiently apparent during a considerable 
period before the occurrence of pulmonary disease, cases do occa- 
sionally occur, and the subjects are chiefly delicate young females, 
where tuberculous disease is indicated by such faint signs, and 
steals on so imperceptibly, that the patient may be on the brink of 
the grave, before the friends are aware of the existence of danger ; 
but this is rare, and will be still more so, when the symptoms 
which indicate the approach of this insidious disease are more gene- 
rally known and attended to. 

Tuberculous cachexy is sometimes complicated with chlorosis, 
and in such cases the latter is often considered the primary disease, 
the error not being discovered till those means so successfully, in 
general, employed to combat it, are found to produce a very tem- 
porary benefit only. 1 

The disordered state of health which I have just described may 
manifest itself in the child at birth, or it may be induced at any 
period of life by the exciting causes to be presently noticed; al- 
though the operation of these is more rapid before the body has 
acquired its full maturity, than at a later period of life. 

Hereditary Origin. — A patient labouring under tuberculous 
cachexy, entails on his offspring a constitutional predisposition to 
consumption. But it is a grievous, although a very common error, 
to suppose that this predisposition is derived from consumptive and 
scrofulous parents only. The offspring of persons labouring under 
a deranged state of health, it matters not from what cause, are very 
generally predisposed to tuberculous diseases. When this truth is 
generally recognised and acted on. a greatly improved state of the 
public health will be the consequence. 

From whatever causes the hereditary predisposition may have 
originated, the earlier in life the means of correcting it are adopted 
the more successful will they be. Our efforts to improve the health 
should commence with the birth of the infant, and be continued 

1 In Dr. Ashwell's Practical Treatise on the Diseases Peculiar to Wo- 
men, will be found some judicious remarks on this state of disease. 



PULMONARY CONSUMPTION. 33 

till it has reached maturity. But the errors committed in the nur- 
sery, and too often continued during childhood and youth, rather 
tend to confirm and augment the hereditary delicacy ; and such 
will be the case till parents are taught to entertain more correct 
views respecting the means of promoting the health of their off- 
spring. 1 

Exciting Causes. — Whatever deteriorates the health may lead 
to tuberculous cachexy ; residence in a low, damp, and chilly 
atmosphere; long confinement to close, ill ventilated rooms, whe- 
ther nurseries, school-rooms, or manufactories ; deficient exercise 
in the open air ; improper food, either deficient in quantity or of 
m nutritious quality; or the habitual use of an overstimulating 
diet. In short, imperfect digestion and assimilation may induce 
tuberculous cachexy ; and the earlier in life these causes are ap- 
plied the more rapidly in general will their effects be manifested. 
The offspring of the healthiest parents may thus become tubercul- 
ous in early life, if long exposed to the exciting causes enumerated. 

I shall now endeavour to state, with as much precision as the 
nature of the subject admits, what may reasonably be expected 
from change of climate in tuberculous cachexy, and in consump- 
tion at the different stages of its progress, and under its different 
complications. 

For the removal of the deranged state of the health, which has 
been shown to precede consumption, a change to a milder climate 
is a very powerful remedy, when aided by such other means as the 
peculiar circumstances of the case may require. Before making 
such a change, however, the functions more evidently deranged 
should, as far as possible, be restored to a healthy state. 

In a large proportion of cases, the functions of the digestive 
organs and skin, as I have already remarked, are deranged, and, 
until they are improved, we shall make little progress in remedying 
the constitutional disorder, even under the influence of the best 
climate. But the means employed for effecting this should be 
directed with judgment and moderation. It must be recollected 
that we have to deal with a constitution either hereditarily weak, 
or which has been brought into its present condition by a long 
series of morbid actions^ and cannot be at once forced back into a 
healthy state. Even when inflammation exists, we must keep in 
mind that it is inflammation in a disordered habit, and apply our 
remedies accordingly. For if the strength is now broken up, and 
the balance of the circulation suddenly disturbed by debilitating 
remedies, the system may lapse rapidly into tuberculous cachexy. 
On the other hand, stimulating or irritating remedies will be equally 
pernicious. In the cases now under consideration, local congestion 

1 Dr. Combe's recent work on the Physiological and Moral Management 
of Infancy, will effect a vast improvement in nursery management, and in 
the health of children. It is the most valuable work on the subject of health 
which has ever been published, aud no parent capable of reading his own 
language should be without it. 

I — c 3 dark 



34 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

and irritation often exist with general debility ; and it requires 
more judgment to manage this pathological state, than almost any- 
other with which I am acquainted. The principal object, in such 
cases, is to promote a more free and regular distribution of the cir- 
culating fluids through the parts in which they have been defi- 
cient, and to relieve those parts or organs which have been over- 
loaded. This will be best done by a mild, nutritious diet, suited 
to the state of the digestive organs ; by exercise in the open air, 
especially on horseback, proportioned to the strength of the patient ; 
by the use of the warm bath ; by cold sponging, and friction of the 
surface, especially on the chest and extremities. In short, the 
whole system being deranged, we must not content ourselves by 
directing attention to one or two disordered functions ; but, by ope- 
rating on all, endeavour to raise the standard of health generally. 

The removal of gastric or bronchial irritation, when it exists, 
and the regulation of the bowels, are the circumstances which 
chiefly require the employment of medicines. The proper appli- 
cation of these in each individual case, must depend on the judg- 
ment of the medical attendant. 

The deranged functions having been corrected, and the general 
health improved as much as the circumstances of the case admit, 
the patient may change his climate with well grounded prospects 
of permanent advantage. 

Unfortunately, it too often happens, that the period of constitu- 
tional disorder, which we have just been considering, is permitted 
to pass ; and it is not until symptoms of irritation or impeded func- 
tion in the lungs, such as cough, difficult breathing, or spitting of 
blood, appear, that the patient or relations are alarmed, and that 
fears are expressed that the chest is " threatened." Such symp- 
toms are but too sure indications that tuberculous disease has 
already commenced in the lungs. It may, indeed, be difficult, in 
some cases, to ascertain the positive existence of this, although by 
a careful examination of the chest, and an attentive consideration 
of all the circumstances of the case, we shall seldom err in our 
diagnosis ; and it need not, at any rate, affect our practice ; as a 
strong suspicion of the presence of tubercles should lead us to adopt 
the same precautions, as the certainty of their existence. 

When tuberculous matter is deposited in the lungs, the circum- 
stances of the patient are materially changed. We have the same 
functional disorders which existed in the former state : and we have 
also pulmonary disease, predisposing to a new series of morbid 
actions — to bronchial affections, haemoptysis, inflammation of the 
pleura, and lungs, &c, which calls for important modifications in 
the plan of treatment. Removal to a mild climate, especially if 
effected by means of a sea-voyage under favourable circumstances, 
may still be useful, on the same principle as in the former case — 
namely, as a means of improving the general health, of preventing 
inflammatory affections of the lungs, and even perhaps arresting 
the progress of the disease. 



PULMONARY CONSUMPTION. 35 

When consumption is fully established — that is, when there is 
extensive tuberculous disease in the lungs, little benefit is to be 
expected from change of climate ; and a long journey will almost 
certainly increase the sufferings of the patient, and hurry on the 
fatal termination. Under such circumstances, therefore, the pa- 
tient will act more judiciously by contenting himself with the, most 
favourable residence which his own country affords, or even by 
remaining amid the comforts of home, and the watchful care of 
friends. And this will be the more advisable when a disposition 
to sympathetic fever, to inflammation of the lungs, or to haemopty- 
sis, has been strongly manifested. 

It is natural for relations to cling to that which seems to afford 
even a ray of hope ; but did they know the discomforts, the fatigue, 
the exposure, and irritation, necessarily attendant on a long journey 
in the advanced period of consumption, they would shrink from 
such a measure. The medical adviser, also, when he reflects upon 
the accidents to which such a patient is liable, should surely hesi- 
tate ere he condemns him to the additional evil of expatriation ; 
and his motives for hesitation will be increased when he considers 
how often the unfortunate patient sinks under the disease, before 
the place of destination is reached ; or, at best, arrives there in a 
worse condition than when he left his own country, and doomed 
shortly to add another name to the long and melancholy list of his 
countrymen who have sought, with pain and suffering, a distant 
country, only to find in it a grave. When the patient is a female, 
the objections to a journey apply with increased force. In these 
advanced cases the patient's sufferings may often be alleviated, and 
life prolonged, by confinement to apartments kept at a regulated 
temperature. 

There are, however, cases of chronic consumption, in which the 
disease of the lungs, even though arrived at a very advanced stage, 
may derive benefit from a mildclimate. The tuberculous affection 
in such persons is generally limited to a small portion of the lungs, 
and the system sympathises little with it. In instances of this 
kind, a residence for some time in a mild climate, especially when 
aided by proper regimen, may be the means of prolonging life. 
Likewise, in those fortunate but unhappily rare cases ; in which 
the disease in the lungs has ceased to extend, and a long period 
must elapse before the work of reparation is completed, a mild cli- 
mate will be of considerable service by improving the general 
health, and preserving the patient from the operation of many 
causes, likely to renew irritation in the lungs, and to which he 
would necessarily be exposed in this country. 

In such cases, life may be preserved for many years by a con- 
stant residence in a mild climate, and by sedulously avoiding, at 
the same time, whatever is calculated to produce congestion, or ex- 
cite inflammatory disease in the lungs. During my residence 
abroad, I met with several invalids labouring under this chronic 

3* 



36 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

form of disease, who passed their winters in Italy with infinitely 
more comfort and enjoyment of life than in England. 

Choice of Climate. — When change of climate is decided on, the 
next subject which naturally presents itself for consideration, re- 
gards the selection of that which is most suitable to the case. The 
question has been often put to me — which is the best climate? 
The truth is, no one climate or situation is the best in all cases. In 
a subsequent part of this work will be found the characters of the 
different climates usually resorted to by invalids, and a compara- 
tive estimate of their merits. With regard to the climates of the 
south of France and of Italy, I may here observe, that for con- 
sumptive invalids, in whom there exists much sensibility to harsh 
and keen winds, and, more especially, if immediate vicinity to the 
sea-coast is known to disagree, Rome or Pisa is the best situation 
for a winter residence. When, on the contrary, the patient labours 
under a languid, feeble circulation, with a relaxed habit, and a dis- 
position to congestion or to hemorrhage, rather than to inflamma- 
tion, and, more especially, when the sea-air is known by experience 
to agree, Nice deserves the preference. In cases complicated with 
gastritic dyspepsia, however, Nice is an improper residence: its 
climate being decidedly inimical to such a state. The climate of 
Hyeres may be considered as nearly similar to that of Nice. The 
influence of such a morbid condition of stomach, in modifying all 
other diseases, is sufficient to claim for it the chief consideration in 
deciding upon the particular climate ; although, I fear, it is but 
seldom thought of. Judging, however, from experience, 1 should 
say, that where this state of the stomach exists, a climate which is 
unsuited to it will do the patient little good, whatever may be the 
ostensible disease for which he is sent abroad. 

With those cases of chronic consumption, therefore, to which I 
have alluded, and which, according to my observation, are almost 
invariably complicated with, and, I believe, in a large proportion of 
cases, chiefly induced by disorder of the digestive organs, Nice will 
decidedly disagree. Besides, such patients have generally an irri- 
tated state of the bronchial membrane, a dry skin, and a morbid 
degree of sensibility of the nervous system — in all of which states 
that place is unfavourable. Rome or Pisa will agree better with 
this class of invalids. 

But the climate which, of all others, I consider the best suited to 
consumptive patients generally, is that of Madeira. Tt will be seen 
by a reference to the meteorological tables in the Appendix, and 
from the comparisons drawn, in the article on Madeira, between 
the climate of this island and that of the different situations on the 
continent of Europe, respecting which we have good information, 
that the winter temperature is considerably higher and more equa- 
ble, and the summer heat much more moderate than at any of these 
places. For such consumptive patients, therefore, as are likely to 
derive benefit from climate, I consider that of Madeira altogether 



PULMONARY CONSUMPTION. 37 

the best. And this opinion does not rest merely on a consideration 
of the physical qualities of the climate, but is warranted by the ex- 
perience of its effects. Madeira has also this advantage over all the 
places in the south of Europe — that the patient may reside there 
during the whole year, and thus avoid the inconveniences, and 
even risks, attending a long journey, to which consumptive inva- 
lids, who pass the winter in Italy, are exposed. The summer cli- 
mate of the whole shores and islands of the Mediterranean, is un- 
suited to consumptive invalids; and, indeed, is known by experience 
to be so pernicious to them, that sailors and soldiers attacked with 
the disease in the Mediterranean fleet, and garrisons of Malta, &c, 
are sent to England on the approach of summer. 

The two places which, from the character of their climate, ap- 
proach most nearly to Madeira, are Teneriffe and the Azores. 
During the winter, the temperature of Santa Cruz, on the southern 
coast of Teneriffe, is several degrees higher than at Funchal ; and, 
in this respect, would prove a superior winter climate for some 
pulmonary invalids. 

The climate of Bermudas is changeable, and holds out no ad- 
vantage to the consumptive invalid. That of the Azores, on the 
contrary, is remarkably mild and equable, and suitable to cases in 
which a soft and rather humid atmosphere is indicated. 

But various circumstances require to be taken into consideration 
before we decide upon a particular climate in any individual case. 
The age and constitution of the patient, the peculiarities and com- 
plications of the disease; his ability to bear traveling, or a sea- 
voyage ; the means at his command, and the friends by whom he 
can be attended, are circumstances which should be taken into 
account, in weighing the comparative advantages of different 
places, and the inconveniences attending all of them, when com- 
pared with the comforts and resources of home. These collateral 
circumstances may render it proper to recommend change of cli- 
mate to one palient, when another, to whose case such a measure 
is equally applicable 3 will be better advised to remain in his own 
country. 

The winter climates in England most favourable to consump- 
tive patients are those of Torquay, Undercliff, Penzance, Clifton 
and Hastings. The choice among these places will depend upon 
the nature of the case, and especially upon the condition of the 
digestive organs. For persons of an inflammatory constitution, 
with a disposition to gastritic dyspepsia, Torquay will form the 
best residence, while it will as decidedly disagree with persons of a 
very relaxed habit, and subject to copious secretions from the mu- 
cous membranes, or to atonic dyspepsia. Such patients will bear 
the climate of Torquay for a very short time only. What has been 
said of Torquay, applies with equal force to Penzance, and the 
other parts of the Land's' End. Undercliff, Hastings, and Clifton, 
wiil form preferable residences in the constitutions referred to. 

In some cases, the relation of the disease to the climat3 is so 



38 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

nicely balanced, that it may be advantageous to send the patient 
for a few months in the early part of winter to one place, and the 
remaining part of the season to another. Torquay, for example, 
may suit remarkably well for two or three months, at the end of 
which time it may be advantageous for the patient to change to a 
less relaxing climate. The winter at Torquay, or Penzance, and 
the spring at Clifton will suit some patients much better than con- 
tinuing the whole season at any one of these places. For the par- 
ticular character of their climates, and effects on disease, I must 
refer to the second part of this work. 

During the summer, great advantage will be derived from fre- 
quent change of place in almost all cases, as will be pointed out in 
the article on summer residences. 

There is one circumstance connected with the residence of con- 
sumptive patients, concerning which the profession are not quite 
agreed — I mean the preference given to a sea-side, or an inland 
situation. We have indeed, no very satisfactory comparisons on 
this subject, in which the nature of the climate, occupations, habits 
of life, &c, of the inhabitants have been fairly and fully taken into 
account, so as to enable us to judge how far the frequency of con- 
sumption, in any particular place, may be connected with the na- 
ture of the climate, and how much may depend on the mode of 
living, (fee. The question is certainly a very difficult one, and in- 
volves a great variety of circumstances not easily analysed ; hence 
it is, that we have little more than opinions, formed from imperfect 
data on the subject. From all that I have been enabled to learn 
and observe, consumption is, I think, cceteris paribus, more fre- 
quent on the sea-coast than in the interior ; l still the greater mild- 
ness of many maritime places, as of those on the south and south- 
west coasts of England, may more than compensate for this differ- 
ence, especially when these places are resorted to for a part of the 
year only. 

In Italy, Rome is the only place, frequented by invalids, suffi- 
ciently remote from the sea to be considered as having an inland 
climate ; and here the comparison is certainly in favour of the in- 
land situation. But my impression is, that there is less difference 
between the sea-side and inland situations, in that range of latitude, 
than further north ; perhaps owins: t0 tne greater dryness of the 
sea-side in southern climates. Of two climates, the physical cha- 
racters of which were alike, the one on the sea-shore, and the other 
inland, I should prefer the latter as a residence for a consumptive 
patient, more especially if the disease were in an advanced stage ; 
but I am ready to admit that this opinion is unsupported by any 
very accurate or numerous data. In America the opinions of medi- 
cal men are greatly in favour of the interior. 

' The comparisons in this respect, which have been made between the 
sea-coast and interior, of large continents, I do not consider applicable to 
small islands. 



PULMONARY CONSUMPTION. 39 

The idea that the air of a marshy country is beneficial in con- 
sumption, is now, I believe, entirely abandoned. Scrofula, and 
even consumption, is more frequent in many aguish districts, than 
in others of a different character ; and an attack of ague is much 
more likely to favour the occurrence of consumption than to pre- 
vent it. 

A sea- voyage is another measure, regarding which a difference 
of opinion prevails among professional men. My own opinion is, 
that a voyage is generally beneficial in the early stage of consump- 
tion. The sickness and vomiting are highly useful in many cases, 
and I believe, the unceasing motion of a ship, by the constant ex- 
ercise it produces, is also very advantageous. It was to this chiefly, 
that the celebrated Gregory attributed the benefit derived from a 
voyage. Several striking instances of the beneficial effects of a 
sea-voyage in consumption, fell under my notice while in Italy ; 
and Dr. Peebles, now of Edinburgh, whose long residence at Leg- 
horn gave him a favourable opportunity of observing the effects of 
the voyage on consumptive patients sent from England to Pisa, 
met with many examples of the same kind. On examining the 
notes of the cases, with which Dr. Peebles favoured me, I find that 
haemoptysis existed in every one of them ; and this was also the 
case in most of the examples which came under my own observa- 
tion. The circumstance of the patient being subject to haemoptysis, 
in the early stage more especially, I should, therefore, consider as 
affording no objection to a sea voyage. 1 

In the consumptive cases, also, which are complicated with pal- 
pitation, or increased action of the heart, whether purely functional, 
or depending upon organic disease, I consider a voyage useful, and 
much preferable to a land journey. There are complications, on 
the other hand, which render a voyage unadvisable. When there 
is much nervous sensibility, a strong disposition to headach, and an 
irritable state of the stomach, a sea-voyage will generally disagree. 
With these exceptions, I should say, that a consumptive patient, in 
whose case a foreign climate is likely to prove useful, had better 
go by sea than by land, provided a vessel can be obtained with 
good accommodations. Much depends upon this last circumstance, 
and much also on the climate or season in which the voyage is 
made. The motives for preferring a voyage to a journey will be 
still stronger, when the patient has not the means of traveling in 
the most comfortable manner. Sailing or cruising for some time 
would be still preferable to a voyage ; and the Atlantic is more 
favourable for this purpose than the Mediterranean. When a long 
voyage is objected to, shorter voyages, under favourable circum- 
stances, and repeated at short intervals, might be of essential bene- 
fit. An objection to sea-voyages, is the length of time that the 
patient is necessarily confined to the close and relaxing air of the 

1 See Dr. Combe's Physiology, &c., already referred to, p. 107, for a re- 
markable example of the benefits of a sea-voyage. 



40 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

sleeping places ; but this is far more than compensated for by the 
facilities which he enjoys of being constantly on deck during the 
day, and there breathing the purest and most salubrious air. To 
take advantage of this with safety, however, let the invalid be pro- 
vided with an ample store of warm clothing, and wrapped up suf- 
ficiently to be able to spend the whole time of daylight on deck 
without being disagreeably chilled. 

The measures which have been recommended as necessary pre- 
parations for a long journey, are equally requisite in the case of a 
voyage — much of the benefit of which will depend upon the con- 
dition in which the patient is sent to sea, and the regimen he 
adopts while there. 

When it is deemed proper to send a consumptive invalid abroad, 
his best residence will be found in one or other of the places which 
have been noticed : and when it can be so arranged that he may 
change his climate several times, it will generally be to his advan- 
tage. When change of climate is wisely adopted for the improve- 
ment of the general health, and before local disease is established, 
a far wider range may be permitted to the traveller. The whole 
south of Europe is open to him, and if he manages his voyages 
and travels judiciously, he may improve his health more than by 
remaining the whole season in any one place. But while great 
latitude may be allowed, over-exertion in traveling, and exposure 
to harsh cold weather, should be avoided, especially by the more 
delicate, otherwise they may lose more than they gain. The total 
want of proper accommodation and means of conveyance must also 
limit the extent of their wanderings. 

in short, general rules only can be laid down for such cases. In 
the guidance of each individual, an outline is all that can be traced 
by the physician ; but the use of a little common sense and discre- 
tion on the part of the traveller, will enable him to fill up the detail 
of his tour, so as to derive the maximum of benefit with the mini- 
mum of those disadvantages which are inseparable from all kinds 
of traveling. 

With respect to the length of time requisite for a consumptive 
invalid to pass in a mild climate, in order to overcome the disposi- 
tion to the disease, no general rule can be given. When the mea- 
sure is had recourse to for the removal of the disordered health 
which precedes tuberculous cachexy, a single winter will be of 
great benefit, and possibly all that may be necessary. When tuber- 
culous cachexy is established, and still more, when there is reason 
to suspect the presence of tubercles in the lungs, several years may 
be requisite, and in some cases it may be necessary to reside per- 
manently in a mild climate. 

When, by the influence of climate and other measures, pulmo- 
nary disease has been warded off, or when it has ceased to make 
progress, every thing calculated to excite irritation in the lungs 
should be carefully avoided ; as a tendency to a return of the con- 
stitutional and local disorder remains long after the symptoms have 



PULMONARY CONSUMPTION. 41 

disappeared. Where the disease has advanced a step further, and 
a cure has nevertheless been effected during a residence in a mild 
climate, the patient should remain there for a considerable time 
(some years if possible) after every symptom of the disease has dis- 
appeared. The same plan of treatment, and the same climate 
which enabled the constitution to effect a cure, should be continued, 
if possible, till the respiratory organs and system have accommo- 
dated themselves to the new condition of the parts. This may, 
indeed, be such that the individual shall not be able to live in any 
other climate. Under whatever circumstances he may be placed, 
such a person must make up his mind to live with great regularity 
and temperance during the remainder of his life. He will bear 
neither full living nor much bodily fatigue; although regular and 
moderate exercise in the open air, and above all, riding on horse- 
back, will be of the greatest service to him. Fulness and excite- 
ment, especially as affecting the pulmonary organs, are what he 
has most to dread. Although the disease has ceased to advance, 
the lungs cannot be restored to their former dimensions ; they must 
remain diminished in capacity in proportion to the extent of tuber- 
culous disease which existed. The chest can therefore neither be 
so fully expanded, nor the blood so freely circulated through the 
lungs as before. Hence, as the capacity of the respiratory organs 
is diminished relatively to the bulk of the body, there will be a 
constant tendency to a plethoric or congested state of the pulmo- 
nary system ; and if the quantity and quality of the food, and 
degree of bodily exertion, are not adapted to the new condition of 
the lungs, hemorrhage or inflammation of these organs will be the 
consequence ; and may speedily terminate a life, which, by a rea- 
sonable degree of attention and prudence, might have been pro- 
longed many years. A mild and moderate diet, with abstinence 
from every thing exciting, can alone preserve such persons. The 
state of the digestive organs requires particular attention, as con- 
gestion in them will speedily lead to a similar state of the lungs ; 
and when this plethoric condition of the abdominal and pulmonary 
circulation exists in a considerable degree, either hemorrhage from 
the bowels, or lungs, or apoplexy, or inflammation of some impor- 
tant organ, can scarcely fail to be the consequence. This, accord- 
ingly, is the manner in which such patients are often suddenly 
carried off. In these cases, therefore, the slightest indication of 
pulmonary congestion or inflammation, should be immediately 
attended to. 

Artificial climate. — In place of sending consumptive patients to 
pass the winter in a foreign climate, it has been proposed to keep 
them at home, in rooms maintained at a regulated temperature. 
With the advocates of such a measure, the state of the lungs ap- 
pears to be the only consideration ; but, without improving the 
general health, by exercise in the open air, all our measures, 
directed to the local disease, will be of little avail — the removal of 
the constitutional disorder can alone afford the patient a hope of 



42 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

recovery. In tuberculous cachexy, therefore, and even in incipient 
stages of consumption, particularly in young persons, I consider 
such a measure generally most inadvisable. But, in the advanced 
stages of consumption, when removal to a distant climate is worse 
than useless, life may be prolonged, in many cases, by keeping the 
invalids in apartments, the temperature of which is regulated, and 
the air maintained in a pure state. Females will, cceteris paribus, 
bear such a system of confinement better than males, from the cir- 
cumstance of its being more congenial to their usual habits of life. 

In cases of inflammation of the lungs occurring during the win- 
ter, in persons predisposed to consumption, keeping the patient 
entirely to the house, in a regulated temperature, till all symptoms 
of the disease have ceased, or even until the return of mild wea- 
ther, will often be very judicious. But when a person so circum- 
stanced has the means, he should pass the following winter in a 
climate where confinement will be unnecessary, and where he can 
improve his general health by exercise in the open air. 

Comparing, then, the benefits to consumptive patients, likely to 
be derived from a mild climate, and confinement to rooms regu- 
lated to an agreeable temperature, there can be no question of the 
decided superiority of the former. But when circumstances pre- 
clude the possibility of changing the climate, and the patient is 
found quite unfit to bear exposure to the external air in this coun- 
try, then confinement to apartments, properly and equably heated, 
is the best measure we can adopt to avoid the injurious effects of 
our cold, damp, and variable atmosphere, during the severe season. 

Various plans have been tried for keeping up a uniform tempera- 
ture, and at the same time preserving the air in a state of purity, 
but hitherto with very imperfect success. The common fire-place 
is the worst of all means, and strong objections attach to almost 
every other in use. The self-regulating stove, invented by Dr. 
Arnott, secures an equable temperature, both night and day, at a 
minimum expenditure of fuel and trouble, The objection brought 
against it, in common with all other close stoves, that the apart- 
ments cannot be at the same time properly ventilated, can have 
arisen only from inattention on the part of the objectors to that 
portion of Dr. Arnott's work which treats of ventilating, and in 
which effectual means are described for securing this important 
purpose, not only in connection with the stove, but generally. 

When means are adopted for insuring the escape of the impure 
air from the upper parts of the room, the ventilation may be made 
much more perfect with Dr. Arnott's stove than with a common 
fire. 

But it is scarcely possible to maintain a steady temperature in 
one or two apartments, the doors of which have to be frequently 
opened, unless the air of the whole house is warmed on its first 
entrance. This may be effected by having a self-regulating stove 
in the lobby or entrance hall, through which the principal supply of 



PULMONARY CONSUMPTION. 43 

air passes. An additional reason for maintaining the air through- 
out the house at a certain degree of warmth, is, that it enables the 
invalid to leave his apartments without experiencing any material 
change of temperature in the stairs or lobbies. 

In addition to any particular arrangement, for keeping up a 
constant ventilation, it would be of great advantage to have the 
windows completely thrown open for a few minutes every day, 
when the invalid leaves his room, in order that the air throughout 
the whole apartment may be completely renewed. The walls being 
always warm, the cold air admitted will very soon be raised to the 
proper temperature. 

By thus securing purity as well as warmth of the air, not only 
in the rooms occupied by the invalid, but throughout the whole 
building, the injurious effects which would result to the constitution 
from passing the winter within doors, may be in a great measure 
obviated, and the utmost advantages which can accrue from it 
secured. 

The invalid who has passed some months in an artificial climate, 
established within doors, should, previously to his first going out 
into the open air, habituate himself to changes in the degree of 
temperature in his apartments ; and when he does venture out it 
should be with proper precautions. 

The respirator will prove a valuable protection to him in the 
first instance, and for some time afterwards, on any sudden or con- 
siderable fall of temperature. Indeed, the habitual use of this 
instrument may, in some cases, be made a substitute for climate. 1 
By maintaining in their houses a uniform and comfortable degree 
of warmth, both night and day, and by the use of the respirator out 
of doors, many persons who labour under chronic bronchial disease 
might escape the great aggravation of it, which never fails to dis- 
tress them every winter. Those who dislike the appearance of the 
metallic respirator may contrive one for themselves, of a less format 
appearance. 

By keeping up the habit of going daily into the open air, m 
almost all weathers, under the protection of warm clothing, and, in 
certain cases, with the additional assistance of a respirator, during 
the prevalence of cold winds, persons with very delicate Kings may 
bring themselves to bear this climate, and even strengthen their 
constitution to an extent not generally believed. If, in addition to 
this daily exposure to the open air, for a longer or shorter period, 
according to the state of the weather, the temperature of our houses 
were better regulated, we should meet with much fewer examples 
of pulmonary and other diseases, generally attributed to the vicis- 
situdes of our climate, but for which we are more indebted to the 
alternations of temperature created by ourselves, and the neglect 

1 Mr. Jeffrey has brought his respirator to a state of great neatness ; and 
has reduced the price to the lowest rate, in order that the poor may avail 
themselves of it. 



44 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

of those precautions and means of defence which are within our 
power. 1 



DISEASES OF THE LARYNX, TRACHEA, AND BRONCHI. 

In no class of complaints, is the beneficial action of change of air 
and climate more speedily manifested, than in irritations of the 
organs of respiration. In the slighter bronchial affections, a change 
to a very short distance only, has often a remarkable effect ; coughs 
ceasing in the course of a few days, which had resisted medical 
treatment for many weeks. But in protracted cases the disease 
assumes a more fixed character, and requires a thorough change 
of climate to produce much effect upon it. 

Some previous treatment will generally be necessary to prepare 
the patient for deriving full advantage from such a change ; and 
he should he made acquainted with the various causes likely to 
increase his disease while traveling. The long continuance of the 
disease is no reason for disregarding these precautions, as chronic 
inflammation may be easily excited during a journey into an acute 
form. 

The next circumstance which requires attention in bronchial 
diseases, is the state of the digestive organs. Irritation of the lungs, 
more especially after the middle period of life, is very often a sym- 
pathetic affection, depending upon irritation of the stomach and 
duodenum and congestion of the liver. Accordingly, on tracing 
the progress of chronic bronchial diseases, we shall generally find 
that they were preceded for some time by a disordered state of the 
digestive organs. In such cases, the cure depends more upon the 
correction of the primary disorder, than upon the direct influence 
of climate on the organs of respiration. Indeed the chronic, and 
even the acute inflammations of the chest, are comparatively of 
easy management when the digestive organs are in a state of in- 
tegrity — when the abdominal circulation is unembarrassed, and the 
various secretions connected with digestion, free and natural. 2 

When, therefore, the patient is suffering from dyspepsia, this 
should be remedied, as far as possible, before he leaves his own 
country; otherwise the change, so far from proving beneficial, may 
be injurious to him. 

The skin will also require our particular attention, as it is seldom 
in a healthy condition in persons who have long laboured under 
bronchial irritation. 

For the general management of such invalids during the journey, 

1 For some excellent advice on this subject I refer to Dr. Combe's Prin- 
ciples of Physiology applied to the Preservation of Health, &c, chapter vii., 
eighth edition. 

2 For some very judicious remarks on this subject, I beg to refer to the 
notes on the article Pneumonia, in Dr. Forbes' translation of ilaennec. 



DISEASES OF THE LARYNX, TRACHEA, AND BRONCHI. 45 

I beg to refer to the article on that subject, at the commencement 
of the second part of this work ; and to the article on " Disorders 
of the Digestive Organs," for directions respecting regimen ; as 
these are strictly applicable to the class of diseases now under con- 
sideration. One remedy, however, namely, warm bathing, which 
is highly useful in dyspeptic complaints, requires to be employed 
with much caution in bronchial, and still more in tracheal and 
laryngeal irritations; and, unless by medical advice, it had perhaps 
better be omitted altogether ih these cases during the journey. 

Besides these important considerations, which the physician alone 
can regulate, there are some minor circumstances which claim the 
attention of the patient; and respecting which he can minister to 
himself. Persons labouring under irritation of the respiratory organs 
should be particularly careful during the journey, and, indeed, at 
all times and in all climates, to avoid currents of air. Although it 
is important that they should take daily exercise in the open air, 
when the weather is favourable, it is far better to remain for a few 
days within doors, than to expose themselves to a cold and humid 
atmosphere, or to cold winds. 

To persons suffering from bronchial irritation, or who are very 
liable to that complaint, the application of cold water, or salt, or 
vinegar and water, to the chest and neck every morning, followed 
by active friction, is very useful. This practice might be generally 
adopted, with great advantage, at all seasons in this country, where 
colds and inflammatory sore throats are among the most prevalent 
complaints. 1 

By means of cold sponging or the shower bath, and friction, and 
the occasional use of the warm bath, with a steady perseverance 
in a mild regimen and regular exercise, particularly on horseback, 
a surprising change may often be effected in the health and feelings 
of delicate persons, and their sensibility to cold greatly diminished. 

Warm clothing is particularly necessary, and flannel next the 
skin, during the day, I consider indispensable. "When the trachea 
is the seat of the affection, the neck and upper part of the chest 
should be particularly well covered, during: the winter and spring, 
with flannel or chamois leather. The lower extremities should 
be kept warm; and I wish it to be understood, that these precau- 
tions are as necessary in the south of Europe as in this country : 
for, although in the former the weather is altogether considerably 
warmer and drier, and the winter much shorter, than in England, 
the alternations of temperature are quite as great, while the houses 
are colder. The spring, too, in the south of Europe, is very irritat- 

,{ 'In my own experience," says Dr. Forbes, "the effect of sponging the 
chest with cold water and vinegar once or twice a day has proved of im- 
mense benefit to delicate subjects, and more especially to those liable to 
catarrhal affections, and to -persons decidedly phthisical. In these cases, 
although no doubt the practice proves tonic to the system generally, I con- 
ceive its chief operation is in lessening the sensibility of the lungs to the 
impression of cold." — Translation of Laennec, 3d Edit. p. 98. 



46 CLARK ON THE SANATIVE INFLUENCE OP CLIMATE. 

ing; and hence, during that season, the greatest circumspection is 
required, on the part of the class of invalids for whom I am now 
writing. 

With respect to the best winter residence, I found Rome agree 
more decidedly with such patients than any other place on the Con- 
tinent ; and I repeatedly had occasion to compare its influence with 
that of the other climates upon the same patients. The climate of 
Rome is not, however, so beneficial when the disease is accompanied 
with copious expectoration, and a relaxed state of the system, as 
that of Nice ; but in the dry tracheal and bronchial affections, the 
climate of Rome, and also that of Pisa, is preferable. Rome has 
several obvious advantages over the other residences on the Conti- 
nent, for patients labouring under bronchial irritation. It is little 
liable to high winds, the air is soft, and the surrounding country 
well adapted for riding, — the best exercise for such patients. 

But at Rome, the invalid labouring under bronchial disease will 
find reason for much self-denial. He must be cautious in his visits 
to the cold galleries and churches, and to such of the ancient ruins 
as are damp, or subject to currents of air, else he will run the risk 
of repeated relapses. During a strong northerly wind he should 
not stir out of doors. I have known a single ride, during the preva- 
lence of this wind, produce a renewal of the disease in a patient 
who had been steadily improving for several months. 

With the exception of cases in which there is a copious expecto- 
ration, and a relaxed state of the system, the climate of Madeira 
proves very beneficial, and is preferable to any part of the Conti- 
nent. In this country, Torquay is the best climate in the dry 
bronchial irritations; for those with copious expectoration, a relaxed 
condition of the system, or an atonic state of the digestive organs, 
Undercliffand Clifton afford better climates. Invalids of this class 
may derive great benefit from a well directed tour during the sum- 
mer, or rather frequent changes of air and place ; for this is much 
more beneficial to them, more particularly if females, than a con- 
tinuous journey. Traveling rapidly seldom fails to derange the 
system in some degree, and this will in a great measure be coun- 
teracted by short journeys, and resting at different places a week or 
ten days ; at the same time, to be effectual, the tour should extend 
over a considerable extent of country, and all those precautions 
which have been suggested as necessary on a journey ought to be 
attended to. 

It is scarcely necessary, after what has been said on diseases of 
the mucous membrane of the digestive and respiratory organs, to 
enter on the subject of similar diseases of the mucous surfaces of 
other parts. It may suffice to observe, that in chronic irritation of 
all these membranes, a mild climate will generally prove beneficial. 



ASTHMA. 47 



ASTHMA. 



Asthma is a term applied in common language, to various diseases 
in which difficulty of breathing is a prominent symptom. In tech- 
nical language it implies a disease in which the difficulty of breath- 
ins: occurs in paroxysms. Asthma is very often sympathetic of a 
morbid state of some other important organ, as the heart, the diges- 
tive organs the womb, &c. Before recommending climate, or any 
other remedy, to an asthmatic patient, therefore, the state of these 
organs ought to be carefully enquired into. In almost all cases of 
asthma, the digestive organs are disordered. The skin is also very 
often dry, harsh, and not unfrequently affected with eruptions. The 
connection between the morbid state of the skin and this disease is 
rendered very evident, in some cases, by the first attack of asthma 
succeeding to, and apparently depending upon, the disappearance 
of some cutaneous complaint, which had been injudiciously removed 
by local applications, while the cause of it was neglected : this I 
have known to occur at the early age of five years. 

In no disease, perhaps, is the effect of change of climate so con- 
spicuous as in asthma. Taking the disease generally, it may be 
stated, that a removal to a warmer climate is highly beneficial; but 
the degree of relief will depend greatly upon the climate being 
suited to the particular case. We must not, therefore, prescribe for 
a name, but take into account the whole pathological condition of 
the patient, in order that we maybe enabled to fix upon the climate 
best suited to his case. 

The following forms of asthma require attention, in prescribing 
change of air or climate. 

Pure Nervous Asthma. — It is difficult to say what place will 
agree best with this form of asthma. The general constitution of 
the patient, and his past experience in the particular quality of air 
which suits him, will assist us in deciding. This form of the 
disease is comparatively very rare, and I did not see a sufficient 
number of cases while abroad to enable me to state any thing very 
positive respecting the influence of particular climates on it. What 
very often passes for simple spasmodic asthma will be found, on 
closer examination, to be complicated with that diseased state of the 
mucous membrane of the lungs, termed dry catarrh, an affection 
which generally remains latent for a considerable time, and is very 
often overlooked ; nevertheless it is a very frequent cause of asthma. 
In this form of disease, the climate of Rome will generally be found 
to agree well. 

Humid Asthma. — This variety is asthma complicated with 
chronic bronchitis, and is one of the most common forms of the 
disease. It may be either idiopathic, or symptomatic of disordered 
digestive organs; in the former case, it is commonly much bene- 
fited by the climate of Nice ; which is also often useful in the 
latter variety, although the amount of benefit will depend on the 



\ 

48 CLARK ON THE SANATIVE INFLUENCE OP CLIMATE. 

kind and degree of the gastric affection of which the asthma is 
symptomatic. On this subject I need not repeat what has been 
already said in the articles on dyspepsia and bronchial diseases. 

Cardiac Asthma.— Asthma dependent upon, or complicated with 
disease of the heart, may receive temporary relief from a mild 
climate; but the nature of the primary disease demands the chief 
consideration, as upon our power of abating it, must mainly depend 
our hopes of any permanent effect being produced on the asthma. 
When change of climate is adopted, in this complication, a voyage 
is preferable to a land journey. 

In asthma complicated with chronic irritation of the bronchial 
membrane, or of the digestive organs, or with a congestive state of 
the hepatic system, or an unhealthy condition of the skin, a course 
of warm mineral water will prove of much benefit. 



GOUT. 



In the early stages of this disease, if the patient possesses sufficient 
resolution to adhere to a regimen calculated to remove the gouty 
disposition entirely, a residence for some time in a mild climate 
will greatly favour his endeavours. 

In confirmed cases, when the joints are permanently affected, and 
when serious inroads have been made on the constitution, a mild 
climate very often improves the state of the general health, and 
prolongs the interval between the paroxysms. 

The regimen of the gouty invalid, residing in the south of Eu- 
rope, while it requires to be regulated according to the circum- 
stances of the individual case, should also be adapted to the climate. 
If the disease is in an early stage, and a cure is expected, a very 
mild regimen is necessary; and, as a part of this, total abstinence 
from wine, [n the chronic form of the disease, the previous habits 
of the patient must be taken into consideration, in regulating his 
regimen. A mild diet will, however, be more necessary in Italy 
than in England. Sweet acid wines, should be avoided ; but the 
sound French wines, especially those of Bourdeaux, will soon be 
found to agree with the generality of such invalids ; and, contrary 
to the general belief, prove less "gouty," and less injurious to the 
health, than the more spirituous wines of Spain, Portugal, and 
Sicily: abstinence from all kinds of wine is still better; and might, 
I believe, be often successfully adopted even in cases of gout of 
long standing. 

Warm mineral waters, employed both internally and externally, 
prove very beneficial in chronic gout, and are well calculated, in 
many cases, to improve the general health, and restore the tone of 
the affected parts. 1 

1 See Appendix on Mineral Waters. 



DELICACY IN CHILDHOOD AND YOUTH. 49 



CHRONIC RHEUMATISM. 

A residence for some time in a mild climate proves of the greatest 
benefit in chronic rheumatism. Nice and Rome are the best cli- 
mates on the Continent, according to my experience. Rheumatism 
is very often complicated with and kept up by a disordered state 
of the digestive organs, without the removal of which the affection 
of the joints can scarcely be cured. In cases of this nature, when 
gastritic irritation exists, Rome is the better climate ; while, in the 
pure chronic rheumatism, Nice deserves the preference, — as it does 
also in those complicated forms of rheumatism, in which the disease 
exists in combination with an atonic or relaxed state of the stomach. 
In cachectic rheumatism, or that chronic affection of the joints de- 
pendent upon a cachectic state of the system, and when the disease 
is complicated with anomalous eruptions, Nice has also appeared to 
agree well. 

When a winter passed in Italy fails to remove the rheumatism, I 
would recommend a course of some of the mineral waters on the 
Continent, known to be most beneficial in such cases. 



DELICACY IN CHILDHOOD AND YOUTH. 

There are two periods in early life, when a residence for some 
time in the south of Europe has appeared to me particularly useful. 

The first is during childhood, from about the third or fourth year 
upwards. At this age children often become delicate and subject 
to catarrh on slight exposure to cold, to gastritic irritation, consti- 
pated bowels, swelling of the lymphatic glands, and other symp- 
toms indicating a strumous disposition. In such cases a temporary 
residence in a warm climate proves very beneficial. During* my 
residence in the south of Europe, I found the health of delicate 
English children, whether of a strumous habit or otherwise, very 
much improved by one or more winters in Italy. The mildness 
and dryness of the Italian winter, and, still more, its shortness, 
compared to that of this country, sufficiently explain the beneficial 
effects produced on the little invalids. Their delicate frames are 
not chilled so much, nor for so long a period of the year, as in our 
own climate, while they are enabled to be much more in the open 
air ; a circumstance of the greatest importance to delicate children, 
and for the want of which nothing can compensate. I must here, 
however, restrict my praise to winter alone, as the summer in Italy 
has often an injurious effect upon such children, especially if the 
residence is prolonged beyond a single season. 1 

1 The winter in Italy provesuseful in difficult dentition, but summer is, in 
the same degree, pernicious. Infants in Italy should generally be suckled 
for a longer period than in England; and it is a rule never to wean them in 
the spring while teething. 

1 — d 4 dark 



■V* 00 CLARK ONvlpHE SANATIVE INFLUENCE OF CLIMATE. 

Rome and Nice are, according to my observation, the best winter 

v vresiderfces fojjSMfldren.^ The general characters of their climates, 

and the opportunities which the surrounding country affords for 

exercise,^jja<e these places a superiority over other towns resorted 

SCHCJC^^Irangers in Italy. When the digestive organs are in an irri- 

state, Rome will be the more suitable residence. On the other 

hand, if there is a torpid, languid state of the constitution, Nice 

affords a preferable climate. 

Children subject to chronic croup will derive advantage from a 
winter passed in Italy ; for although this disease is generally con- 
nected with a disordered state of the digestive organs, it is often 
induced by exposure to cold and damp, in children predisposed to 
it. Croup is scarcely known in southern Italy; and among child- 
ren who had previously had the disease, no relapses, 1 believe, 
occurred during my residence at Rome. 

When there is a disposition to hydrocephalus (comparatively a 
rare disease, I think, in the south of Europe,) and when there is 
not much gastritic irritation, the same change of climate will be 
useful. 

But by far the most important disease of childhood, and that 
which, when rightly understood, forms the key to the treatment ot 
almost all diseases occurring at this period of life, is a disordered 
state of the digestive organs. This subject is, in my opinion, so 
important and so intimately connected with the design of the present 
work, that I deem no apology necessary for entering at some length 
into it. 

Dyspepsia in Children. — A deranged state of the digestive organs 
is the source of most ot the chronic, while it aggravates, and in- 
creases the danger from all the acute diseases to which childhood 
is liable, such as hooping-cough, measles and scarlatina. If ne- 
glected, it also leads to an unhealthy youth, and imperfect develop- 
ment of the body ; but above all, it is the principal cause of that 
morbid state of the system which has been denominated tuberculous 
cachexy. In the hygeienic management of children, therefore, it is 
of the utmost importance that correct views should be entertained 
respecting the nature and causes of disorders of the digestive 
organs. 

Dyspepsia may assume the same characters in childhood as in 
the more advanced periods of life, but by much the most frequent 
and destructive form of the disease is that which has been named 
by medical writers Strumous Dyspepsia^ from its being intimately 
connected with scrofula in all its forms. 1 

The symptoms in the early stages vary much in degree in child- 
ren of different constitutions. When not well marked they may 

1 Strumous Dyspepsia has been admirably described by my late lamented 
and talented friend Dr. Todd, in his able article on Indigestion, in the Cyclo- 
paedia of Practical Medicine. To that article I beg to refer the medical 
reader for a full account of dyspepsia in all its forms. 



DELICACY IN CHILDHOOD AND YOUTH. 51 

exist a considerable time without attracting much notice. The 
child is thirsty, feverish and restless in the early part of the night, 
and towards morning often becomes bathed in copious perspirations. 
The tongue is generally florid, and towards the point the papillae 
are prominent and red. The appetite is variable ; the bowels costive, 
and the motions generally pale ; the urine is high-coloured or turbid. 
As the disease advances, the tongue becomes more loaded, the breath 
fetid, the countenance loses its natural colour and animated expres- 
sion ; the child looks pale and pasty, and the flesh is soft ; the 
appetite is at times craving, and at other times there is no desire for 
food. If the little patient be neglected or improperly treated, the 
skin becomes harsh and dry, the abdomen tumid, the extremities 
waste, the eyelids are swollen and inflamed, and puriform discharges 
occur from the ears ; the glands of the neck become enlarged, 
and cutaneous eruptions not unfrequently appear. The child is 
now on the verge of tuberculous cachexy, into which he soon lapses 
unless judiciously treated. Dr. Todd is of opinion, that this form 
of dyspepsia is more characteristic of the strumous or tuberculous 
disposition than any of the external signs which have been usually 
trusted to as its indications. 

A change to a mild climate under such circumstances will be of 
the utmost advantage to the child. During summer, frequent 
changes of air will be productive of great benefit. In the early 
part of the summer, the interior, — and towards the end, and during 
the autumn, the sea-side will best suit such children. But no 
general measure of this kind should be adopted, till the morbid state 
of the digestive organs is in some degree corrected ; and wherever 
a child goes, this should receive constant attention. For although 
the general health may be much improved by change of air, or 
climate, the improvement will not be permanent unless the conges- 
tion and irritation of the digestive organs, in which the disorder 
had its origin, and on which its continuance depends, are removed. 
With this view every means calculated to correct this state should 
be adopted. The most important is the regulation of the diet. 
This must of course be varied according to the age of the child, 
and the degree of congestion and irritation which exists. Gene- 
rally speaking, the diet should be of the blandest quality, more 
especially in children of an excitable constitution. When the 
tongue is red, the skin hot at night, with thirst, milk and farinaceous 
food should constitute almost the sole nourishment. As the irrita- 
tion abates, a little mild animal food every second day is allowable. 
For children of a more torpid character of constitution, who have 
little disposition to fever, when the tongue is loaded, and all the 
functions languid, a more exciting diet may be permitted. The 
warm bath and friction will be beneficial in all cases, more especially 
in the languid constitutions just alluded to. The great objects in 
the treatment should be, to regulate the diet, according to the sensi- 
bility and power of the digestive organs, to promote an active state 
of circulation in the surface and extremities, with a view to remove 

4* 



52 CLARK OX THE SANATIVE INFLUENCE OF CLIMATE. 

the congestion and irritation of the internal organs, and to impart 
tone to the system. Without removing the morbid state of the 
duodenum, and the congestion of the liver and abdominal organs 
generally, it will be in vain to expect a free state of the circulation 
in the surface and extremities, a healthy condition of the skin, or 
the power of resisting cold. This irritation of the digestive organs 
influences every function of the body, and without its removal, all 
remedies directed to the improvement of the general health will 
produce only a partial and evanescent effect. 

This is not the place to discuss the medical treatment, but I can- 
not resist the occasion of entering my caveat against the inconsi- 
derate routine practice generally adopted in such cases. Active 
mercurial purgatives, an exciting diet of animal food, not unfre- 
quently repeated several times a day, with the addition of porter or 
wine, or both : and this followed by steel and other tonics, constitute 
generally, in this country, the treatment of scrofulous children. 
Such a mode of treatment is at total variance with the gastro-duo- 
denal irritation and hepatic congestion, which are present in a 
greater or less degree in all cases of scrofula. Besides this, com- 
plete want of success attends it in practice, whilst striking benefit 
is derived from an opposite plan of treatment. 

When change to a distant rlimate cannot be accomplished, a resi- 
dence in some of the milder situations in our own island will often 
be of great service in improving the health of delicate children. 
The sea-coast is considered the best residence for scrofulous child- 
ren, and deligate young persons jjenerally. This opinion, however, 
is not always correct; and even when sea-air is desirable, it is not 
a matter of indifference what situation is chosen. There is a con- 
siderable variety in the climate of the different places on the sea- 
coast resorted to by invalids. 1 For some cases of scrofula, a dry, 
bracing air, such as that of Brighton, will be the most suitable; for 
others, the more sheltered situations of Undercliff or Hastings ; and 
the mild and soft climate of the south-coast of Devon will, in many 
cases, prove a very favourable winter residence ; whilst during the 
summer months, a dry elevated part of the interior, such as that 
afforded by the Malvern Hills, will often be superior to any part of 
the sea-coast. 

The second period of youth at which I consider a mild climate 
more decidedly beneficial, is about puberty. It frequently happens, 
at this age, that from pursuing a course of study too assiduously, 
especially during the debility consequent upon rapid growth, or 
from various other causes, the health is materially injured ; the 
whole system is debilitated, and the changes which take place at 
this period of life, either do not appear, or do so imperfectly, and 
the development of the body is not fully accomplished. The young 
person loses his usual colour, plumpness, and strength ; the face is 
pale, and the features are fallen ; the skin dry and harsh, or relaxed 

*See article on Consumption. 



CLIMACTERIC DISE- 53 

and moist or the former state alternates with general or partial per- 
spirations : cutaneous eruptions are also common ; the feet are very 
liable to become cold ; the bowels are constipated : the tongue 
loaded, and the digestive organs disordered. The nervous system 
-lorbidlv sensitive, and the temper irritable, or there is great 
mental depression, and the whole moral character is often remark- 
ably changed : there is an indifference to the objects and pursuits 
which previously interested the mind, and a disinclination for either 
bodily or mental exertion. Tuberculous disease often shows itself 
under such circumstances, for the first time. 

One of the most powerful means of preventing such disorders 
when threatened, and of removing them when they have occurred, 
temporary residence in a warm climate : and when the person 
is known to have a hereditary predisposition to consumption, the 
measure is more urgently called for ; as the deranged condition of 
the system ; if not soon corrected, may terminate in the constitutional 
disorder which we have seen to be the precursor and essential cause 
of consumption. If change of climate cannot be accomplished, 
the winter should be passed in some of the milder parts of our own 
island, where by exercise in the open air. warm sea-bathing, and a 
well regulated diet, much may be done to rescue the youthful in- 
valid from the impending danger. 

Although I have particularly noted early childhood and puberty, 
as the periods of life at which a mild climate proves signally bene- 
ficial, there is no period of youth at which it may not be had 
recourse to with advantage, under the circumstances pointed out. 



CLIMACTERIC DISEASE 

We have just seen that climate may be made available for the 
correction and removal of derangements of health, occurring in 
youth and impeding the development of the body : we also find 
that, as age advances, and the system begins to feel tfa it of 

Eimate proves highly beneficial in arresting premature 
decay. 

At the age of from fifty to sixty, sometimes earlier, a remarkable 
change often takes place in the health, without any rery obvious 
cause. The person's appearance becomes greatly altered ; his 
strength is diminished, and he generally becomes thin, and Ic 

a unequal to the mental aud bodily exertions to which 
he has been habituated ; and the consciousness of this frequently 
induces a depression of spirits and fretfulness of temper; or these 
may exist as direct effects of the bodily disorder. With the more 
general evidences of deteriorated health, some organs of importance 
to life, most frequently, the digestive organs, show symptoms of 
disorder. An habitual morning cough, with more or less of ex- 
:oration, cutaneous erupt;: .iugs, and pains in the joints, 



54 CLARK ON THE SANATIVE INFLUENCE ON CLIMATE. 

or nervous affections, chiefly of a painful kind, amounting even to 
tic-douloureux, often precede and accompany this state : or the in- 
dividual lapses into a general cachexy, without much evident local 
disease. The whole system is, I believe, in these cases, in a morbid 
condition. If such a person is attacked with any acute disease, the 
constitution may sink under it with great rapidity. 

This state constitutes what is not unaptly termed in common 
language "a breaking up of the constitution;" which, in truth, it 
generally proves to be, if not judiciously treated. 1 

These symptoms of premature decay originate often in too much 
mental exertion, close attention to business, and its consequent cares 
and anxieties ; frequently they are the effects of a sedentary life 
and an habitual system of full living; more frequently still, they 
are the result of the combined influence of these causes. From 
whatever cause the disorder proceeds, one or two winters passed in 
a warm climate, with the adoption of such a regimen, and the use 
of such other remedial measures as the particular case may require, 
will prove of essential service in arresting the progress of decay, 
and restoring the invalid to a state of better health. 

Dr. Warren, of Boston, United States, informed me, that he had 
frequently been struck with the beneficial influence which a visit 
to Europe had in renovating the health of his countrymen about 
the middle period of life, when the constitution had begun to flag, 
from application to business and the cares and duties of life : and 
he himself experienced, from his visit, a similar improvement in his 
own health. 

The change of climate, in this case, is no doubt a very complete 
one, and is accompanied with all those favourable circumstances 
which contribute so much to aid climate in the restoration to health. 
Any thing, indeed, more likely to produce a favourable change in 
the constitution, and call forth its latent energies, than a visit to 
Europe by a citizen of the United States, can scarcely be imagined. 

When a change of climate cannot be accomplished, great benefit 
may be obtained from a change of air in our own country ; from 
the use of warm or tepid sea-bathing, and a course of such warm 
mineral waters as are suited to the case. But to derive permanent 
benefit from these measures, the invalid must henceforth change his 
mode of life, and eschew those causes which first brought him into 
jeopardy. 

Persons just returned to Europe, and whose constitutions have 
suffered by a long residence in a tropical climate, will find great 
advantage in spending one or more winters in the south of Europe 
before finally settling in this country. 2 The great object in such 

1 See an excellent paper on the Climacteric Disease, by Sir Henry Hal- 
ford, Bart., President of the Royal College of Physicians. — Medical Trans- 
actions, vol. iv. p. 316, &c. 

2 For some very judicious advice to persons returning from a warm climate, 
the reader is referred to Dr. James Johnson's Essay on Morbid Sensibility 
of the Stomach and Bowels as the Cause of Indigestion, &c. Tenth edi- 
tion. 1840. 



CLIMACTERIC DISEASE. 55 

cases is to maintain an active state of the circulation on the surface 
and extremities, by warm clothing, exercise, friction, and the use 
of the warm bath. By these measures, any sudden change in the 
relative state of the circulation and secretion of the skin and in- 
ternal organs, the consequence of a removal from a hot to a cold 
climate, will be obviated, and pulmonary and hepatic diseases pre- 
vented. 1 

Friction in particular may be made a most efficient means of 
promoting an active state of the cutaneous circulation. The flesh- 
brush, horse-hair gloves, or flannel, may be used, according to the 
sensibility of the skin ; but the friction, to be effectual, should be 
active, and applied over the whole surface, particularly the extremi- 
ties. Sponging the chest and arms every morning with cold water, 
will also aid in promoting the same objects. When the skin is 
torpid or relaxed, friction may be advantageously employed, before 
the cold sponging as well as after it. 

When the biliary system is greatly deranged, a frequent occur- 
rence with natives of this country who have passed some time in 
India, a course of mineral water will prove very useful, particularly 
after a winter spent in the south of Europe. Mineral waters are 
frequently found to remove what are commonly called biliary symp- 
toms, indigestion, low spirits, &c, by restoring a regular and healthy 
action of the liver, of the bowels, and of the skin. 2 

There are various other states of impaired health, in which 
change of air and climate prove very beneficial. Indeed it would 
be difficult to name the chronic complaint, or the disordered state 
of health, which would not admit of being ameliorated by the judi- 
cious adoption of such a measure. 

In the convalescence from fevers and other acute diseases, no 
remedy is so effectual in restoring the invalid to health, as a well- 
timed change of air ; and if the disease has had its origin in causes 
dependant upon the locality, such a change is almost essential to 
recovery. But the amount of benefit to be derived from change of 
air will depend greatly upon the judgment with which it is employed 
both as regards the condition of the patient and the selection of the 
place. The convalescence from acute diseases should be fully 
established, before the removal is attempted, otherwise a relapse, in 
place of improvement, is very likely to be the consequence. 

Ague affords an exception to this rule. In this disease the first 

•The great prevalence of pulmonary diseases among the natives of tropi- 
cal climates who come to this and other cold countries, is doubtless, chiefly 
owing to the influence of a cold and humid atmosphere upon their system. 
It is in such persons, and in young children, that tuberculous diseases are 
more speedily induced, and where inflammation appears more intimately 
connected with the production of tubercles. The rapid progress of the 
disease, in both classes of persons, is to be explained, principally, I believe, 
by the circumstances of their habit of body being that which is most dis- 
posed to tuberculous affections, — the most nearly allied to tuberculous 
cachexy. 

2 See Appendix on Mineral Waters. 



56 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

intermission should if possible be taken advantage of to remove the 
patient from the situation in which it has occurred, and a farther 
residence in which will render the cure difficult. The remedies 
which will produce little effect upon an intermittent fever, in the 
locality where it originated, will often effect a speedy cure when 
the patient is removed elsewhere. 

The selection of the place will depend in some measure on the 
nature of the complaint. It should always be of a different charac- 
ter from that in which the patient lives, more especially in the 
malarious class of diseases to which we have just alluded. For a 
person who has had acute pulmonary disease, a mild air and 
sheltered situation will be the most favourable, until the pulmonary 
irritation has subsided ; after which another change to a more 
bracing air may be attended with great advantage, especially to 
persons of a languid and relaxed system. The object desired by 
the first change is to soothe and allay irritation in the affected organs ; 
by the second, to give tone to the system generally. A succession 
of changes will in almost all cases prove more beneficial than a 
residence at any one place. 

Children profit by change of air with surprising rapidity ; and 
there are few cases of deranged health at an early a^e in which it 
does not merit the first rank in the list of remedies. Delicate females 
also benefit greatly ; indeed, in proportion to the natural suscepti- 
bility of the individual, is the beneficial influence of a judicious 
change of air evinced. It is to the young and delicate the best and 
often the only admissible tonic; and we have daily occasion to 
regret the straitened circumstances which keeps many such patients 
lingering in a state between health and disease, in the confined air 
of the city, or in some equally unhealthy residence in the country, 
when they might be restored to health and vigour, by a temporary 
change to a purer air. 



PART THE SECOND 



ON CLIMATES. 



INTRODUCTORY REMARKS. 

Besides Directions for invalids; before commencing a journey, 
while traveling, and during their residence abroad, a few observa- 
tions on Ventilation and Unhealthy JResideticcs may advantage- 
ously find place here, as the subject is one having immediate refer- 
ence to that which has just been considered, as well as to that about 
to engage our attention. 

Ventilation. — The necessity of pure air for the maintenance of 
health is so little understood, and the ventilation of houses in con- 
sequence so thoroughly neglected, that a few observations on the 
subject will not be out of place in a work, the chief object of which 
is to inculcate the value and direct the application of air and 
climate, as means of preserving health and curing disease. 

Nothing contributes more effectually to strengthen the system, 
and render it capable of bearing the vicissitudes of climate, than the 
constant respiration of pure air. On the other hand, nothing tends 
more certainly to weaken and relax the constitution, and render it 
susceptible of the impression of a cold and humid atmosphere, than 
breathing impure air. 

When an equable temperature combined with free ventilation is 
generally provided for in our houses, there will be a great improve- 
ment in the public health. 

In the construction of a house, the dimensions of the bedrooms 
and the means of ventilating them, ought to be most important con- 
siderations, whereas they are comparatively little thought of. No- 
thing, indeed, can be constructed on a worse principle than the 
bedrooms in this country generally are. Their small size and their 
lowness render them very insalubrious, unless well ventilated; and 
the case is rendered worse by the close windows, and by the thick 
curtains with which the beds are so carefully surrounded, as if to 
prevent the possibility of the air being renewed. The consequence 
is that the occupants are breathing vitiated air during the greater 
part of the night, that is, during almost one half of their lives. 1 

1 The remarkable lowness of the bedroom floors in numerous new houses 
at this moment building in and around London, affords abundant proof of 
the truth of these remarks. 



58 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

These remarks, in regard to the importance cf free ventilation in 
bedrooms are still more applicable to nurseries, school-rooms, and 
all places occupied by the young; as also to the work-shops of that 
numerous class of our population engaged in sedentary occupations. 

To secure effective ventilation, or a continuous renewal of the 
air in all inhabited rooms, the pure air should be made to enter 
from below, and the deteriorated air to escape from above, — a cir- 
culation in accordance with the natural motion produced in fluids 
by difference of temperature, and prevented only by the ignorant 
interference of art. To understand the proper method of ventilating, 
we have only to attend to the currents which take place naturally 
in all inhabited rooms. Air, as it increases in temperature, or 
becomes loaded with watery vapour, has its weight diminished, and 
is forced up, if means are not taken to prevent it. Now the air in 
an inhabited apartment being both heated and generally combined 
with a portion of watery vapour, by respiration, dec, becomes speci- 
fically lighter, at the same time that it is vitiated, and the most im- 
pure part rises to the roof. If it had the means of escape, it would 
be gradually driven out by an equal quantity of pure air entering 
below, which, becoming heated and deteriorated in its turn would 
in a similar manner ascend and escape; thus would a continual 
renewal of the air ^o on without any trouble on our parts. Unless 
provision be made for the escape of the ascending current of impure 
air, no admission of external air will secure ventilation. 1 

Unhealthy Residences. — If it is necessary to secure proper venti- 
lation within our dwellings, it is no less necessary that the air 
around them should be pure and salubrious. The best internal 
arrangements for ventilation, cannot change the character of the 
external air, nor prevent its injurious effects on the health of the 
inmates. 

Persons living in low damp or confined situations, rarely enjoy 
that degree of vigorous health of which their constitution admits. 
Without suffering from any formal disease, they are subject to 
various complaints which often embitter their life, and render them 
much less capable of bodily and mental exertion than they would 
be, if placed in a situation more congenial to their constitution. 

Dyspepsia, and its various concomitants, headache?, general 
nervous irritability, and a variety of anomalous nervous complaints, 
with languor and depression of spirits, may be enumerated among 
the evils resulting from a residence in unhealthy situations. All 
these ailments, in addition to others peculiar to the sex, are more 
severely felt by females, because they are more susceptible, and at 
the same time more confined to the influence of the locality in 
which they reside; and during infancy and childhood, the effects 
of a confined, humid air are most destructive; at this early age 

8 For more detailed explanations with respect to ventilation and the means 
by which it may be carried into effect, the reader is referred to Dr. Arnott's 
Elements of Physics, or to his Treatise on Warming and Ventilating. 



INTRODUCTORY REMARKS. 59 

scrofula is almost the certain consequence of residing in such a 
locality. 

Under these circumstances, nothing affords so effectual and speedy- 
relief as a change of residence, even for a short time, to a drier and 
more elevated situation, and a more bracing air. In very many 
instances, this is indeed the only means of restoring the person to a 
better state of health. The increase of strength and buoyancy of 
spirit — the mental energy, as well as bodily vigour, which persons 
residing in a close humid atmosphere experience on changing to a 
dry. open, and elevated part of the country, surprise and delight 
them, and they hope that this state of well-being may be perma- 
nent ; but a return to their former residence soon convinces them 
that their feelings of increased health were temporary, and depen- 
dent entirely upon their change of residence. 

Much might, no doubt, be done to improve the condition of many 
unhealthy places, by removing all obstacles to a free circulation of 
air, and all sources of humidity, especially stagnant waters, by 
draining, &c. But until the public are fully acquainted with the 
circumstances which require attention in the selection and prepara- 
tion of situations for building, the complaints alluded to, and which 
may be fairly styled malarious, will continue more or less. 

In a climate naturally humid, like that of Great Britain, it is of 
the first importance in the selection of a situation for building that 
it should admit of a free circulation of air and thorough drainage. 
In proportion as the soil is impermeable or retentive of humidity, 
so ought the site of the building to be high, in order to allow of 
sufficient fall for the water to drain off. Surface drainage around 
houses is also a measure which should never be neglected when 
the soil is retentive. 

Trees and thick shrubbery close to houses are not only direct 
causes of impure humidity, but they act still more injuriously by 
impeding a free circulation of air, and the entrance of the sun's 
rays. This is one of the most frequent, and I may add, most pow- 
erful causes of insalubrity in country houses in England ; and the 
case is frequently rendered worse by the addition of stagnant water, 
in the form of ponds. Many country houses, and indeed whole 
tracts of country are rendered unhealthy by the quantity of wood 
alone. The over-wooded state of the parks of many of the nobility 
and gentry, especially in a level country, is a fertile source of ill- 
health, often of positive disease, more especially in the autumn and 
spring, such as fevers, bowel complaints, rheumatism and other 
affections already alluded to, which, although not remarkable for 
severity, are not less causes of distress from their great frequency. 
Were trees around houses, and wood of all kinds, especially thick 
underwood, kept more distant, and were rank grass, stagnant water, 
and other obvious sources of impure humidity removed, and were 
more care taken to drain the surface soil, a marked improvement 
would be effected in the health of the inhabitants of the country 



60 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

generally, and more especially in our thickly wooded and marshy 
districts. 1 

Directions for invalids making a change of climate — I shall 
now endeavour to make the invalid acquainted with the circum- 
stances which demand his more particular attention, previously to 
setting out, — during his journey, and after he is fixed in his new 
residence. This is a matter of the greatest consequence ; and a 
want of due attention to it, is one of the principal causes why much 
less benefit is derived from climate than would otherwise be the case. 

Too much is generally expected from the simple change of cli- 
mate. From the moment the invalid has decided upon making 
such a change, his hopes are solely fixed upon it; while other cir- 
cumstances, not less conducive or necessary to his recovery, are 
considered of secondary importance, and sometimes totally neglect- 
ed. This is an error not always confined to the patient; his medi- 
cal adviser frequently participates in it; nor is this difficult to be 
accounted for. The cases hitherto sent abroad have been, for the 
most part, consumptive, or other diseases, of long standing, in 
which the ordinary resources of our art have failed; therefore, 
when change of climate has at last been determined upon, the phy- 
sician, as well as the patient, is disposed to look upon it as the sole 
remedy. 

But, as I have witnessed, on a pretty extensive scale, the injury 
arising from this over-confidence in the unaided action of climate, 
and the consequent neglect of other things of no less importance, I 
particularly request the attention of invalids to the following re- 
marks. 

In the first place, I would strongly advise every person who goes 
abroad for the recovery of his health, whatever may be his disease, 
or to what climate soever he may go, to consider the change as 
placing him merely in a more favourable situation for the opera- 
tion of other remedies in the removal of his disease ; in fact, to bear 
constantly in mind that the beneficial influence of traveling, of sail- 
ing, and of climate, requires to be aided by such a dietetic regimen 
and general mode of living, and by such remedial measures, as 
would have been requisite in his case, had he remained in his own 
country. All the circumstances requiring attention from the invalid 
at home, should be equally attended to abroad. If in some things 
greater latitude may be permitted, others will demand even a more 
rigid attention. It is in truth, only by a due regard to all those cir- 
cumstances, that the powers of the constitution can be enabled to 
throw off, or even materially mitigate, a disease of long standing, in 
the best climate. 

It may appear strange to some of my readers that I should think 
it requisite to insist so strongly on the necessity of attending to 

1 If a board of health existed in this country, it would be part of their duty 
to draw up and circulate instructions for the construction of buildings, and 
the preparations necessary for rendering them healthy residences. 



INTRODUCTORY REMARKS. 61 

these things ; but I witnessed the injurious effects of a neglect of 
them too often, not to deern such remarks called for in this place. 
It was, indeed, matter of surprise to me, during my residence abroad, 
to observe the manner in which many invalids seemed to lose sight 
of the object for which they left their own cou-ntry. This appeared 
to arise chiefly from too much being expected from climate. 

The more common and more injurious deviations from that sys- 
tem of living which an invalid ought to adopt, consist in errors of 
diet; exposure to cold, over-fatigue, and excitement in what is 
called "sight-seeing;" frequenting crowded and overheated rooms, 
keeping late hours, &c. Many cases have fallen under my observa- 
tion, in which climate promised the greatest advantage, but where 
its beneficial influence was counteracted by the injurious operation 
of these causes. Every invalid who goes abroad, must make up 
his mind to submit to many sacrifices of his inclinations and plea- 
sures, if he expects to improve his health by such a measure. 

In order that the patient may derive advantage from his journey, 
or at least that his complaint may not (as often happens) be increased 
by it, some preparatory measures will generally be requisite before 
he sets out. Traveling is exciting to most people; and to those 
who have chronic inflammation of any organ, however latent or 
obscure, it very often proves injurious, particularly during hot and 
dry weather. Almost every one in health is sensible of the excite- 
ment arising from traveling. The appetite is generally increased, 
while the secretions and excretions are much diminished. The 
consequence is a degree of excitement of the system, not unaptly 
termed by travellers, "a heated state." What in health amounts 
only to a slight degree of excitement, easily removed by a few days' 
rest, and the employment of some common cooling remedies, often 
proves of serious consequence to the invalid who labours under, or 
is even disposed to any inflammatory affection. 

When, therefore, the patient's disease is of an inflammatory nature, 
or threatens to assume such a character, his condition should be well 
examined before he commences a journey or voyage. If any undue 
vascular excitement exists, measures should be taken to reduce it 
by proper regimen, — by rest, by tepid bathing, &c. ; and local, or 
even general bleeding may be requisite in some cases. Simple con- 
gestion, or an overloaded state of the vascular system, general or 
local, will also require to be diminished. In short, before one step 
of the journey is taken, all excitement or plethora should be removed, 
as far as the nature of the case admits. 

Having his system in a proper state when he sets out, the invalid 
should endeavour to keep it so during the journey, — by adhering to 
a light diet, taking care not to overload the stomach even with the 
mildest food, by abstaining from wine and spirits of every kind, and 
by maintaining the regular action of the bowels. The latter object 
is best effected by laxatives, such as castor oil, and electuary of 
senna, or by the use of mild lavements. Purgatives of the more 
drastic kind, such as generally enter into the composition of pills, 



62 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

are apt to irritate the bowels, increase an attack of hemorrhoids, a 
frequent consequence of neglected or irritated bowels while travel- 
ing. When such medicines are used they should be of the least 
irritating nature, and the dose so regulated as to produce a laxative 
effect only. The watery extract of aloes, with mastich and extract 
of hyosciamus, forms one of the best combinations. To these means 
of maintaining the system in a cool state, I may add the use of 
warm or tepid bathing, which should not be omitted where it can 
be conveniently procured, and when there are no objections to it 
from the peculiar nature of the patient's disease. When used with 
the necessary precaution it is free from danger, and will generally 
prove very useful in obviating the exciting effects of traveling. The 
temperature may be from 94° to 97° of Fahrenheit's thermometer, 
according to the feelings of the patient. The forenoon, or, rather, 
just before dinner, is the best period for taking the bath, and from 
twenty minutes to half an hour the proper time for remaining in it. 
By adopting the general regimen mentioned, and by traveling such 
distances only as the strength can bear, resting for a day when it is 
found necessary, the invalid will not only escape the injurious 
effects frequently produced by traveling, but arrive at his winter 
residence in a much better state of health than when he left his 
own country. This, I may observe, however, is a rare occurrence 
in the usual mode of conducting a long journey; for, even when 
no positive increase of disease is the result, the traveller has fre- 
quently sufficient cause to regret his inattention to the precautions 
above mentioned ; as there is induced a degree of general excite- 
ment, and a deranged state of the secreting organs in particular ; the 
injurious effects of which may be felt by a delicate constitution dur- 
ing a considerable part of the winter. The invalid thus not only 
loses the benefit which the journey might have produced, but, in 
part, that also which he would have obtained from his winter resi- 
dence. If the invalid is wise, he will keep these things in mind. 
It. is the duty of his medical adviser to prepare him for his journey, 
by allaying any excitement which may exist in his system, and by 
removing any other morbid affections with which the principal dis- 
ease may be complicated, and which often form insurmountable 
obstacles to recovery. 

Having his system thus prepared, the invalid should, on his part, 
endeavour to maintain it in the same state, by a strict adherence to 
the prescribed regimen. If, during his journey, his pulse should 
become frequent, his skin dry and hot, or if he has thirst or a dry 
tongue in the morning, or if his nights are restless, he may feel as- 
sured all is not right. He is over excited, either by too full a diet, 
by too rapid traveling, by exposure to a hot sun, or by the bowels 
being overloaded. In the generality of such cases, a few days' rest, 
and the use of some such cooling remedies as have already been 
mentioned, will allay the irritation ; and the invalid may then pur- 
sue his journey, taking care to avoid whatever he has reason to 
believe excited him before. 



INTRODUCTORY REMARKS. 63 

Arrived at his place of residence, some measures of the same 
kind will probably be necessary ; as it will rarely happen, that one 
shall reach the end of a long journey, even under the best manage- 
ment, without some degree of temporary excitement or derange- 
ment of the system. The invalid should, if possible, be spared the 
examination and selection of apartments, and particular care should 
be taken to have these thoroughly dry and ventilated before he 
enters them ; this, I may remark in passing, is not to be done in 
any part of the continent of Europe, without the use of fires. 

There are some other circumstances more immediately connected 
with the change of climate, which require to be noticed here. As 
the traveller advances to the south, the sensibility of the system is 
increased, and hence his mode of living should be regulated accord- 
ingly. Persons, for example, bear a diet in England which would 
prove too exciting to them in Italy : some articles of food, also, are 
more apt to disagree in the south ; of this kind are fish, milk, and 
even vegetables, all of which should be used in great moderation by 
persons in delicate health. As soon, therefore, as a person changes 
his climate, he ought to adapt his manner of living to that which 
he has begun to inhabit. Besides the diet, the clothing also requires 
particular attention. This should be as warm during the winter 
in the south of Europe as in England. The feelings are altered 
in respect to temperature, and houses being relatively colder in 
Italy, warmer clothing is necessary within doors than in this 
country. It is advisable, also, to keep the whole apartment at a 
moderate temperature, and to avoid approaching too near the fire. 
To seek also too exclusively the sun's rays is a habit particularly 
injurious in the south of Europe, more especially during the spring. 
From these causes arise headaches, catarrhs, inflammatory affections 
of the chest, and even fevers. 

This seems the proper place to say something of the best periods 
of traveling. With respect to the routes to the different parts of the 
Continent the ordinary Guides and books of Directions for travel- 
lers, contain such full information as to render it unnecessary that 
I should enter on that subject. 

There are two seasons when the invalid, who means to pass the 
winter in Italy, may best leave England, early in June and early in 
September. In setting out at the former period, he may pass the 
summer in Germany or Switzerland, — a plan which will suit the 
health of many. By leaving this country in September, the sum- 
mer heat will be avoided, and, by conducting the journey properly, 
the patient may enjoy a mild climate to the place of his destination. 
But to insure this, nothing should be allowed to interfere with the 
steady progress of the journey, except such periods of repose as the 
invalid may require. The best route will be through Switzerland, 
and across the Simplon. -The proper time for entering Italy is the 
end of September, or early in October. 

For Nice and the south of France, the period of departure need 
not be quite so soon. Although an invalid can scarcely have too 



64 CLARK ON THE SANATIVE INFLUENCE OF CLTMATE. 

much time for his journey; inasmuch as, if conducted with jud£- 
ment, and made at the proper season, it will be more beneficial to 
his health the more time it occupies, within reasonable limits. 
When the weather is chilly, the invalid should not commence his 
journey too early in the morning, nor until he has taken a light 
breakfast; and he should endeavour to arrive at his sleeping quar- 
ters before evening. 

One of the most exciting things to a sensitive invalid is exposure 
to a powerful sun ; this should therefore be sedulously avoided, by 
resting during the middle of the day when the weather is oppres- 
sively hot. 

When there is a disposition to coldness of the extremities, it is of 
essential consequence to the well-being of the patient, to guard 
against this. If the surface and extremities are kept warm, a deli- 
cate person will often bear traveling in a very cool atmosphere, and 
even derive advantage from it. Persons with the slightest disposi- 
tion to inflammation of the throat, trachea, or lungs, should avoid 
exposure to cold or high winds, or a powerful sun, and, still more, 
alternations of these, which are very apt to occur in valleys, and in 
crossing mountains. Invalids should also avoid approaching too 
near a strong fire in the evenings after a journey. 

The foregoing observations I consider to apply, more or less, to 
all invalids going abroad for the benefit of their health : more 
minute instructions respecting the conduct of those affected with 
particular diseases, and while residing at different places, will be 
found in the articles devoted to the consideration of such diseases 
and places. 



CLIMATES OF ENGLAND. 

I shall commence my survey of climates for invalids, with the 
most favourable for winter residences in this country. In my 
account of these I shall have occasion to compare them with each 
other, and with the most esteemed climates in the south of Europe; 
both in regard to their physical qualities, and their influence on 
diseases. 

The Mild Region of England admits of being divided into four 
districts, or groups of Climate: that of the South Coast compre- 
hending the tract of coast between Hastings and Portland Island; 
the Southwest Coast, from the latter point to Cornwall ; the district 
of the Lands-End ; the Western Group, comprehending the 
places along the borders of the Bristol Channel and estuary of the 
Severn. We shall find that each of these regions has some peculiar 
features in its climate which characterise it, and distinguish it from 
the others, both as regards its physical and medical qualities. 



CLIMATES OF ENGLAND. 65 



LONDON. 



As a point of comparison, and for other reasons, it will be useful 
to begin with a brief notice of the climate of the metropolis. Lon- 
don is indebted for the peculiarities of its climate to artificial cir- 
cumstances chiefly. To the crowded assemblage of so many living 
beings; the multifarious processes ministering to their wants; the 
countless operations of art ; the influence of buildings, &c. in re- 
taining, augmenting and diffusing warmth, by reflection, by radia- 
tion, and in other ways. Besides these, the more indirect influence 
of perfect draining and paving, in contributing to maintain a dry 
state of the soil and atmosphere, must be taken into account. All 
these circumstances tend, some in a greater, others in a less degree, 
to the creation of a peculiar climate in London. As regards tem- 
perature, we have their influence very accurately demonstrated ; 
but the subject becomes more difficult when we would discover the 
other elements which constitute the complex problem of climate. 

The mean annual temperature of London is 50° 39, being one 
and a half degree above that of the environs. 1 

This difference of temperature between the metropolis and sur- 
rounding country is very unequally distributed throughout the 
year, and throughout the day. The excess of the city tempe- 
rature is greater in winter than in summer. It is at its maximum 
in January, at whicfe time it exceeds that of the environs by 3°. 
In the spring months, the temperature of the environs becomes 
nearly equal to, and in the month of May rather exceeds that 
of London. That accurate observer, Howard, further shows, that 
this excess of temperature of the city "belongs, in strictness, to 
the nights ; which average three degrees and seven tenths warmer 
than in the country ; while the heat of the day, owing without 
doubt, to the interception of a portion of the solar rays by a 
constant veil of smoke, falls, on a mean of years, about a third of 
a degree short of that on the open plain." 2 As was also to have 
been expected, the temperature of London does not show so exten- 
sive a range between its extremes, either during the year, the month ; 
or the day, as the temperature of its environs ; and the amount of 
variation between the successive days, which shows the steadiness 
of temperature, is also considerably less in the former than in the 
latter. Howard's observations, also, prove that although London 
is warmer than the country, it acquires and loses its heat more 
slowly. It will be the duty of the physician to decide how far this 
gain in warmth, (more particularly in the night,) in steadiness of 

1 The temperature of the environs is calculated from Howard's observa- 
tions made at Plaistow, Stratford, and Tottenham- Green. 

8 The Climate of London, deduced from Meteorological Observations 
made in the Metropolis, and at various Places around it. By Luke Howard, 
Gent. Second Edition, vol. i. p. 237. London, 1833. 

1 — e 5 dark 



66 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

temperature, and in a greater degree of dryness and stillness, is 
counterbalanced by a diminution of the purity of the atmosphere, 
and of other qualities of climate. The benefit so often experienced 
by delicate invalids on coming from the country to London, in the 
winter or spring, is no doubt owing to the qualities of the climate 
above enumerated. It is during the night that the climate possesses 
the greatest advantages for the sensitive invalid; in addition to its 
warmth and dryness the atmosphere is then in its purest state, 
being free from the smoke and dust with which it is loaded and 
obscured during the day, by the numerous fires and the unceasing 
traffic of carriages, &c. 

I shall not at present enter more fully upon the consideration of 
the Climate of London : its peculiarities will be made more apparent 
in the sequel, by the frequent comparisons which we shall have 
occasion to make between it and the other climates which we pur- 
pose to describe : and in the mean time, I can confidently refer those 
who are desirous of further information on the subject, to the excel- 
lent work of Mr. Howard, just referred to, and also to the memoir 
of Professor Daniel, in his ingenious Meteorological Essays. 

THE SOUTH COAST. 

This extensive and populous coast, from its vicinity to the metro- 
polis, and more easy access generally, possesses several obvious 
advantages over the more distant parts of our Island. Various 
places along it are more or less frequented by invalids, who migrate 
from the northern and interior parts of the island in search of milder 
seasons ; but here, as elsewhere, we have to regret that more regis- 
ters of the weather have not been kept. For want of more general 
data, our observations can apply correctly only to Hastings, Brighton, 
Chichester, Gosport, Southampton, and Undercliff, in the Isle of 
Wight. 

Were we to rest contented with the result of the mean annual 
temperature, we should find that there was very little difference 
between that of the South Coast and of London. But when we 
descend to particulars, we observe that there does exist a consider- 
able difference in their temperature, arising from the mode of its 
distribution. It is because the higher degree of the temperature of 
London, and the interior of the island in summer, compensates for 
the lower degree in the winter, that the climate of these places 
appear to equal that of the South Coast. The mean temperature of 
the latter, however, during the winter months, 1 is from one to two 
degrees above that of London. The superiority is greatest in those 
months in the following order :— January, February, December. It 

'It may be proper here to state that, in this work I adopt the more com- 
mon division of the seasons; including under Winter, the months of Decem- 
ber, January, and February; under Spring, those of March, April, and May ; 
under Summer, June, July, and August; and under Autumn, September, 
October, and November. 



CLIMATES OF ENGLAND. 67 

diminishes in March ; and in April the temperature of the coast 
falls nearly two degrees below that of London and its vicinity j 1 in 
May, it is a degree and a half, and in the months of June, July, 
August, and September, about one degree less. In October, the 
mean temperatures are nearly equal, but in November that of the 
coast begins to rise above the other. 

It is important to remark, that the difference of temperature, in 
favour of the coast, during the winter, occurs principally between 
the lower extremes ; so that the temperature of the day is nearly 
the same at both places, whilst that of the night is considerably 
warmer on the coast. For instance, the difference between the 
minima of Gosport and London, during the winter, is to the differ- 
ence of their maxima as seven to three. The minimum tempera- 
ture, observed on the South Coast generally, is from three to four 
degrees above the minimum temperature observed at London. Nor 
is the temperature of the South Coast subject to the same extent 
of range as that of London and the interior. Thus, the difference 
of the mean temperature of the warmest and coldest months in Lon- 
don is 26°, while at Gosport it is only 21° ; and the mean of the 
monthly ranges at London is 34°, and at Gosport only 31°. In 
steadiness of climate, as deduced from the variation of temperature 
between successive days, the South Coast does not appear to possess 
any very remarkable superiority over London itself. Of the places 
on this tract of coast which have been particularly examined, 
Southampton is the most variable in its temperature, equaling in 
this respect the environs of London. 

More rain falls on the South Coast than at London, the ratio 
being, as nearly as could be ascertained, as 30 to 25 : but the quan- 
tity varies considerably at different parts. Of the places on this 
coast, frequented by invalids, Hastings, Brighton, and Undercliff, 
may be considered as having, respectively, peculiar climates. 

HASTINGS. 

This place has long enjoyed the reputation of being: one of the 
mildest and most sheltered winter residences on the South Coast. 
Owing to its low situation, and the height of the neighbouring 
cliffs, it is protected in a considerable degree from all northerly 
winds. To those of the south it is fully exposed ; and although 
the gales from that quarter are less violent on this coast than on 
that of Cornwall and Devonshire, still, during the winter season, 
southwesterly winds often prevail many days successively. In re- 
spect of the degree of protection from northerly and northeasterly 
winds, there is a considerable difference in different parts of Hast- 

1 On the parts of the coast which are more particularly exposed to the in- 
fluence of the northeast winds, this difference of temperature between the 
coast and the interior is still greater, when estimated by its effects on the 
living body. 

5* 



DO CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

ings. 1 The lower situations facing the beach are particularly well 
sheltered by a perpendicular cliff which rises immediately behind 
them. Other parts of the town are more or less exposed, according 
to their elevation and aspect. In another point of great importance 
in the character of a winter residence lor invalids, I allude to 
sheltered exercising ground, Hastings is not very favourably cir- 
cumstanced. It is true, the parade affords a sheltered walk of small 
extent, close upon the beach, and there is a ride along the shore, 
through St. Leonards, which is protected by a range of cliffs from 
northerly winds ; but it is the only sheltered ride of any extent in 
the neighbourhood. 

With respect to the comparative merits of this climate, it may be 
observed, that its superiority in winter appears to be confined chiefly 
to the months of January and February. During these two months, 
and in the spring also, it has the advantage of being more effectual- 
ly sheltered from north and northeast winds, than the other places 
frequented by invalids on the coast of Sussex. Hastings is said to 
be comparatively little subject to fogs in the spring; the fall of rain 
is also said to be less than at other parts of the same coast. 

As might be expected from the low and sheltered situation of 
Hastings, it will be found a favourable residence generally to inva- 
lids labouring under diseases of the chest. Delicate persons, who 
require to avoid exposure to the northeast winds, may pass the cold 
season here with advantage. But in recommending Hastings as a 
residence in both instances, it will be necessary to take into con- 
sideration the influence of sea air ; for, owing to the close manner 
in which this place is hemmed in on the sea by steep and high cliffs 
it has an atmosphere more completely marine than almost any othe. 
part of this coast, with the exception of St. Leonards. 

Judging from my own observation, I should say that the climate 
of Hastings is unfavourable in nervous complaints, more especially 
in nervous headachs connected with, or entirely dependent upon 
an irritated condition of the digestive organs, and, also, in cases 
where a disposition to apoplexy or epilepsy has been manifested. 
But it will be understood from what has been already stated re- 
specting the topographical relations of Hastings, that this effect of 
its climate is chiefly experienced in the lower or more confined 
parts ; nor is such an effect peculiar to this place ; it is common, I 
believe, to all places similarly situated. The class of persons alluded 
to, if induced to reside for any length of time at Hastings, should 
avoid the more confined situations below the cliff, and rather seek 
such quarters as are more open and elevated, yet in some degree 
protected from north and northeast winds. 

1 On the Curative Influence of the Southern Coast, &c, p. 23. Also, On 
the Adaptation of the. Different Parts of Hastings to Different Diseases. By 
Dr. Harwood. 



CLIMATES OF ENGLAND. 69 



ST. LEONARDS. 



This place is about a mile to the westward of Hastings, and, 
like it, possesses a dry and absorbent soil. St. Leonards is separated 
from the sea beach merely by a carriage road and broad esplanade, 
and lies along the base of a range of cliffs which protect it from 
northerly winds. The circulation of the sea atmosphere is more 
free and uninterrupted here than at Hastings, and the cliffs being 
lower, cold draughts, and counter-currents of wind from above are 
less experienced. The breadth and extent of its esplanade also, 
and the protection afforded by the colonnades for walking exercise, 
are circumstances of considerable importance to the invalid. 

In other respects, the climate of St. Leonards may be considered 
as almost identical with that of Hastings. 

Dr. Harwood thinks Hastings and St. Leonards most favourable 
for invalids from November to the end of February. 1 

In the extent and quality of accommodations, St. Leonards much 
exceeds Hastings. 

Ague is not unfrequent in the neighbouring districts ; but Dr. 
Harwood never knew an instance of a visitant being attacked with 
the complaint. 

BRIGHTON. 

Brighton has a climate in many respects the reverse of that of 
Hastings, the air being dry, elastic and bracing ; yet even within 
the limits of Brighton a considerable diversity of climate is to be 
found. The true character of the Brighton climate belongs, in 
strictness, to the part of the town east of the Steyne ; here the air 
is eminently dry, sharp, and bracing. That to the westward is 
somewhat damp, but milder. Delicate, nervous invalids are very 
sensible of this difference, and generally feel better in the western 
part. Those who suffer from a relaxed state of the system, enjoy 
their health more fully on the Marine Parade. The Steyne forms 
an intermediate climate, being sheltered in some degree from the 
cold northeasterly winds, on the one hand, and the boisterous south- 
westerly winds on the other. 

Compared with the other parts of this coast, the climate of Brigh- 
ton appears to the greatest advantage in the autumn and early part 
of the winter; when, as we have seen, it is somewhat milder, and 
more steady than that of Hastings. Accordingly, in all cases in 
which a dry and mild air proves beneficial, Brighton, during this 
period of the year, deserves a preference over every other part of 
the South Coast which I have had an opportunity of observing. 
During the spring months, on the other hand, owing to its exposure 

1 On the Climate of the Hastings Coast; Viewed in Refeience to its Ef- 
fects in Diseases of the Throat and Chest. By John Harwood, M.D., F.R.S. 



70 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

to the northeasterly winds, this climate proves cold, harsh, and ex- 
citing to delicate constitutions. At this season, therefore, sensitive 
invalids generally, and more especially persons with delicate chests, 
should avoid Brighton. The climate of Hastings, as I have already 
remarked, is milder in the latter part of the winter and spring. 

For convalescents, and all persons who require a dry and bracing 
air, and in whose cases the sea shore is suitable, Brighton presents 
one of the most favourable climates which can be selected. For 
children and young persons generally, it forms an excellent resi- 
dence. A large proportion of invalids also, who require to pass 
the winter in the warmer parts of our island, may remain with 
great advantage at Brighton during the autumn. The weather is 
then generally mild, and favourable for exercise on horseback, or 
otherwise, particularly as from the calcareous nature of the soil, 
rain dries up with great rapidity. There is certainly something 
very peculiar in the influence of the air of Brighton upon the 
nervous system. I believe that relaxed nervous invalids, whom it 
does not irritate, feel more vigour and energy here than at almost 
any place with which I am acquainted ; on the other hand, persons 
of an irritable nervous system, or those subject to gastritic dyspepsia, 
or a dry irritable state of skin, will not derive advantage from the 
climate of Brighton ; on the contrary, their complaints will gene- 
rally be aggravated by it. From the disposition to gastric irritation 
experienced at Brighton, invalids, and dyspeptic invalids in par- 
ticular, should adhere to a mild diet, more especially on their first 
arrival. 

From Brighton, the delicate invalid may remove during the 
winter and spring to the more sheltered situations afforded by 
Undercliff, Hastings, or Torquay, a plan which will prove more 
advantageous to many invalids than passing the whole season at 
any one of these places. 

ISLE OF WIGHT. 

The Isle of Wight, from the variety which it presents in point 
of elevation, soil, and aspect, and from the configuration of its hills 
and shores, possesses several peculiarities of climate and situation, 
which render it a very favourable residence for invalids throughout 
the year. 

The part of the island adapted as a winter residence for invalids, 
is that denominated Undercliff, which comprehends a tract of coun- 
try, extending from Dunnose to St. Catherine's Hill, on the south- 
east coast, about six miles in length, and from a quarter to half a 
mile in breadth. This singular district consists of a series of ter- 
races, formed by the upper strata, composed of chalk and green 
sand, which have slipped down from the cliffs and hills above, and 
been deposited in irregular masses upon a substratum of blue marl. 
The whole of the UnderclifT, which presents in many places scenery 
of the greatest beauty, is dry and free from moist or impure exhala- 



CLIMATES OF ENGLAND. 71 

tions, and is protected from the north, northeast, northwest, and 
west winds, by a range of lofty downs, or hills of chalk and sand- 
stone, which rise boldly from the upper termination of these terraces, 
in elevations varying from four to six and seven hundred feet ;' 
leaving Undercliff open only in a direct line to the southeast, and 
obliquely to the east and southwest winds, which rarely blow here 
with great force. 

The physical structure of the Undercliff has been carefully in- 
vestigated and described by the geologist, 2 and the beauties of its 
scenery have been often dwelt upon by the tourist, but its far more 
important advantages, as a winter residence for the delicate invalid, 
seem but recently to have attracted attention. 

The continuous range of high hills which separates this district 
from the rest of the island, protects it most effectually from all 
northerly winds; while numerous short ridges, projecting from the 
main range towards- the sea, break, in a considerable measure, the 
violence of the southwest winds. The protection afforded by this 
northern barrier is greatly increased by the very singular and 
striking abruptness with which it terminates on its southern aspect. 
This, in many places, consists of the bare, perpendicular rock of 
sandstone, in others, of chalk, assuming its characteristic rounded 
form, covered with fine turf and underwood ; but so steep as to 
justify the appellation conferred on the beautiful tract which ex- 
tends from its base to the sea shore. 3 The defence afforded by this 
natural bulwark against northerly winds is, indeed, more perfect 
than any thing of the kind I have met with in this country ; and 
the transition of climate experienced on descending from the exposure 
of the open and elevated down to the shelter of the Undercliff, will 
remind the Italian traveller of his sensations on entering the valley 
of Domodossola, after quitting the chilly defiles of the Simplon, in 
an autumn evening. You feel at once that you have entered a new 
climate ; and the luxuriance of the vegetable tribes, which you find 
around you, proves that the impression made on the senses has not 
been deceitful. 

The whole of the Undercliff, however, is not protected in an 
equal degree. The eastern part, comprehending the country from 
Bonchurch to the village of St. Lawrence, a distance of nearly 
three miles, has, in this respect, the advantage over the western 
portion, which is more open to the southwesterly winds ; but even 
here there are several very sheltered spots ; and the temperature 
does not differ materially from that of the eastern division. The 

1 The height of the range is greatest at its two extremities ; St. Catherine's 
Hill is nearly 900, and St. Eoniface Down 800 feet above the level of the 
sea. The intermediate parts of the range vary from 650 to 700 feet. 

2 See the splendid work of Sir Henry C. Englefield, (which contains Mr. 
"Webster's geological observations,) " A Description of the Principal Pic- 
turesque Beauties, Antiquities, and Geological Phenomena of the Isle of 
Wight." London, 1816. 

3 Undercliff, i. e. under the cliff. 



72 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

whole extent of Undercliff is, indeed, similarly protected from winds; 
and, I apprehend, it will be difficult to find, in any northern coun- 
try, a tract of equal extent and variety of surface, and I may add, 
(as by no means a matter of indifference to the invalid,) of equal 
beauty in point of scenery, so completely screened from the cutting 
northeast winds of the spring, on the one hand, and from the 
boisterous southerly gales of the autumn and winter, on the other. 
The termination of the Undercliff towards the sea shore is in a 
range of perpendicular cliffs, of from forty to sixty, or seventy feet 
in height, rendering it far from being a close and confined situation, 
a circumstance of no inconsiderable importance. It may, there- 
fore, be represented as a lofty natural terrace, backed by a moun- 
tainous wall on the north, and open on the south to the full 
influence of the sun, from his rising to his going down, during that 
season at least when his influence is most wanted in a northern 
climate. 

Owing to its elevation above the level of the sea, the Undercliff 
differs from most of the situations on our coast, in being less exposed 
to the direct and immediate influence of the sea air ; a circumstance 
which, in a medical point of view, deserves consideration. Sea fogs 
are rare, except towards the end of May and during June, when 
they are more or less prevalent. Observation has proved that less 
raiu falls at Undercliff than on the south coast generally, and even 
than at other parts of the Isle of Wight, a circumstance which 
might have been inferred from a consideration of the topographical 
relations of the place. The soil, consisting chiefly of the detritus 
of the sandstone and chalk from the incumbent cliff, is naturally 
dry, and speedily regains its dryness after rain. The nature of the 
rock, and the general shelving form of the surface, likewise con- 
tribute to render Undercliff a dry situation. 

The climate is remarkably equable as well as mild and dry, and 
there are not many days during the winter in which the invalid 
cannot take some exercise in the open air. The mildness of the 
climate, during the winter months, may be in some degree estimated 
by the circumstance of myrtles, geraniums, sweet-scented verbena, 
heliotropes, and other tender plants, usually withstanding the winter 
in the open flower borders. The honey bee likewise continues 
working, in ordinary seasons, until after Christmas. 

To the invalid who has cultivated natural history, this sheltered 
district possesses an additional advantage. It is rich in varied and 
interesting plants, and the specimens of natural history, with which 
it abounds, offer abundant inducement to exercise and mental oc- 
cupation to the cultivators of this delightful science. 

When we consider the numerous local advantages of the Under- 
cliff, already detailed, the result of the Meteorological Observations 
appended, and take into account the still more conclusive evidence 
furnished by the condition of the exotic plants which grow there: 
it is evidently one of the warmest climates in our island, and most 
eligible for a large class of our delicate invalids. With respect to 



CLIMATES OF ENGLAND. 73 

the most decisive evidence of all, in a medical point of view, I 
mean the effects of the climate on pulmonary disease, my experience 
is favourable. 

I have certainly seen nothing along the South Coast that will 
bear a comparison with it; and Torquay is, I apprehend, the only 
place on the Southwest Coast which will do so. But much more 
extended observations than we at present possess for either of these 
places, are required to determine their comparative merits. With a 
temperature nearly the same, the climate of Torquay is soft, but 
humid and relaxing; while that of Undercliff is dry, somewhat 
sharp, and bracing. The winter temperature at these two places 
differs very little. Although at Torquay the temperature some- 
times rises higher, it likewise sinks lower than at Undercliff. giving 
the latter the advantage over it in equability of temperature. These 
qualities peculiar to the two places render them respectively suitable 
in different diseases, in different forms of the same disease, and in 
constitutions of a different character. For pulmonary invalids, the 
best season to be at Undercliff is from November to May. 

It is to be regretted, that with all the natural advantages of the 
Undercliff, the accommodations are far from what they might have 
been. Since the publication, however, of the last edition of this 
work, the accommodations for invalids have been greatly increased, 
and although my suggestions have not been strictly attended to in 
the construction and position of the buildings, they have been so 
in numerous instances. Some good houses have been erected at 
Bonchurch for the accommodation of invalids ; each house is sur- 
rounded by a portion of ground, and care has been taken to inter- 
fere as little as possible with the natural beauties of the place. The 
little village of Ventnor is fast rising into notice ; a handsome church 
has been erected, some ^ood hotels established, and several houses 
built for the accommodation of invalids. 

We have now to consider the advantages of the Isle of Wight, 
as a summer residence for invalids. The Undercliff itself affords 
a mild summer climate ; but as a change of air and scene are 
generally beneficial to the invalid, the summer months may be 
better passed by many in still cooler situations in other parts of the 
island. 

Niton, situated on the western extremity, but without the limits 
of Undercliff, affords a cool summer residence. It has also the ad- 
vantage of being in the vicinity of some of the finest scenery on 
the island, and at no great distance from the celebrated Sand Rock 
Spring. 1 

Cowes is likewise a good summer residence. The accommoda- 
tions for sea bathing are pretty commodious, and it is also conve- 
niently situated for exercise on the water. 

1 This powerful aluminous chalybeate source issues from the cliff, at an 
elevation of one hundred and thirty feet above the level of the sea. It is 
the strongest mineral water of ihe kind with which we are acquainted, and 
is, indeed, too strong to be drunk without large dilution. According to the 



74 CLARK ON THE SANATIVE INFLUENCE OP CLIMATE. 

The little village of Sandown, on the eastern shore, forms a 
retired and pleasant summer residence, and is well suited for sea 
bathing, having a fine sandy beach. Shanklin, in the same neigh- 
bourhood, is a favourite summer retreat, and one of the prettiest 
places in the island. But of all the situations in the island, Ryde 
appears to me to deserve a preference as a summer residence. It 
stands on the slope of a dry, gravelly hill, facing the north ; imme- 
diately opposite Portsmouth ; and from the fine open manner in 
which part of it is built, many of the houses having gardens at- 
tached to them, it possesses most of the advantages of a country 
residence, together with those of a sea bathing place. The neigh- 
bourhood is also very beautiful and favourable for exercise. The 
Isle of Wight thus presents a considerable variety of healthy and 
beautiful sites, suited to the wants of a large proportion of valetudi- 
narians. The proximity to the metropolis, and the rapid and easy 
communication recently established by the Southampton railway, 
add greatly to its conveniences as a residence for invalids. 1 

CLIMATE OF THE SOUTHWESTERN COAST. 

The south coast of Devon has a winter temperature nearly two 
degrees higher than that of the coast of Sussex and Hampshire, 

analysis of the late Dr. Marcet, a pint, or sixteen ounces of this water, con- 
tains the following ingredients; the specific gravity being 1007.5. 
Of carbonic acid gas, three tenths of a cubic inch. 

Sulphat of iron, in the state of crystalised green sulphat, 41 grs. 4 

Sulphat of alumine, a quantity of which, if brought to the 

state of crystalised alum, would amount to ... 31 6 



Sulphat of lime, dried at 160° 
Sulphat of magnesia, or Epsom salts, crystallised 
Sulphat of soda, orglauber salt, crystallised 
Muriat of soda, or common salt, crystallised 
Silica 



10 1 

3 6 
16 

4 
7 



107 4 
From the resemblance of this spring to a celebrated mineral water in 
Sweden, Berzelius was induced to examine it. The results of his experi- 
ments confirmed the accuracy of Dr. Marcet's analysis. It has been found 
useful in the cure of agues, in some cases of dyspepsia, and in general re- 
laxation and debility connected with uterine weakness, &c. For a full ac- 
count of the medical virtues of this spring, I beg to refer to Dr. Lempriere's 
little work on the subject.* There is a hotel near the spring, and I would 
advise dyspeptic invalids especially, for whom this water may be prescribed, 
to drink it at the source. 

1 In terminating my observations on the climate of UnderclifF, I must ex- 
press my obligation to Dr. Martin, the resident physician in the district, for 
his able assistance. By continuing the series of minute and careful obser- 
vations, on which he has already been engaged some years, Dr. Martin will 
soon be enabled to fix the character of the climate of UnderclifF. 



* Report on the Medicinal Effects of the Aluminous Chalybeate Spring, lately dis- 
covered in the Isle of Wight. By William Lempriere, M.D. &c. &c. Second Edition, 



CLIMATES OF ENGLAND. 75 

and from three to four higher than that of London. 1 The differ- 
ence is most remarkable during the months of November, Decem- 
ber and January; amounting, on the average, in the sheltered 
places, to five degrees above London. In February, the difference 
falls to three degrees, and in March and April, the excess of the 
mean temperature over that of London, does not amount to one 
degree. It ought also to be remarked, that this difference takes 
place principally in the night ; as the difference between the lower 
extremes of London and the Southwest Coast, is to the difference 
of the higher extremes as four to three, — a less disproportion, how- 
ever, than occurs between the South Coast and London. Hence, 
when compared with the latter, the days are proportionally warmer 
on the Southwestern than on the Southern Coast ; whilst the nights 
at these places are nearly equal. The range of daily temperature 
is about the same on the Southwest and South Coasts, although, as 
has been remarked, less than at London. . As regards the continu- 
ance of the same temperature, the Southwestern has a remarkable 
superiority over the Southern Coast; amounting nearly to three 
fourths of a degree ; which is a very considerable difference, when 
we reflect that the whole amount of variation of successive days 
scarcely exceeds three decrees. 

Different places on the Southwestern Coast possess these general 
qualities in a more eminent degree, according as they are more or 
less sheltered from northerly and easterly winds. Of these, taking 
them in succession from west to east, Salcombe, Torquay, Dawlish, 
Exmouth, Salterton, and Sidmouth, deserve to be particularly no- 
ticed. But many other sheltered spots may be found along this 
coast, as, for instance, in the neighbourhood of Plymouth, at Kings- 
wear, near Dartmouth, and other places. But the great fault of 
most of these situations is, that their climate is too circumscribed to 
be of much utility to the class of invalids who are in a condition 
to derive the greatest advantage from a mild climate, I mean those 
who are capable of taking exercise in the open air. At a very little 
distance from the coast, several situations may be met with, still 
more completely protected from northeasterly winds, than most of 
the places situated immediately on the sea shore. Among these 
may be mentioned the village of Lympstone, about two miles from 
Exmouth, and Bishopsteignton, about the same distance from 
Teignmouth. To this class of situations, the village of Upton also 
belongs. All these places, while they are sufficiently near the coast 

1 Notwithstanding that public attention has been so long directed towards 
the climate of Devonshire, it is extraordinary how few are the materials 
which can be collected with a reference to the subject. It is to be hoped 
that this may not long continue to afford -a ground of complaint. We should 
think it an object well worth the attention of the scientific institutions of 
Exeter, Plymouth, Bath, Bristol. &c. Were they to establish a series of simul- 
taneous observations at different parts of the country for a few years only, 
the character of the climate of the southwestern part ol England might be 
accurately ascertained. 



76 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

to partake of the mildness of its climate, are beyond the more imme- 
diate influence of the sea air, and are more protected from the 
southerly gales, to which the whole coast is exposed. These cir- 
cumstances deserve the consideration of the physician, while weigh- 
ing the comparative merits of the two classes of places as residences 
for different invalids. The village of Heavitree, close to Exeter, 
although more inland, has the credit of possessing a mild winter 
climate. And this may be true, as far as regards the part situated 
on the southern aspect of the low hill on which the village is built; 
but the other parts are exposed to the whole range of northeasterly 
winds. 

There are other sheltered spots in the immediate vicinity of 
Exeter, which would afford mild winter residences for invalids. 
But it will be found that, as we recede from the coast, the cold, 
especially during the night, is more intense, and the range ot tem- 
perature greater. And, independently of this circumstance, the few 
accommodations to be found at all these places, with the exception 
perhaps of Heavitree, prevent them from being resorted to at present 
by invalids, except in a very limited degree. 

SALCOMBE. 

This small place, (the Montpelier of Huxham,) deserves notice 
here for its remarkable mildness. Yet, although it is perhaps the 
warmest spot on the Southwest Coast, its climate is limited to too 
small a space to admit of Salcombe ever becoming the resort of 
invalids to any extent. 

There is unfortunately here a want of sheltered ground for exer- 
cise ; and this I hold to be one of the greatest defects in a winter 
residence, for a large proportion of invalids. It is indeed chiefly 
for the advantage of exercise in the open air, that they leave the 
comforts of their own homes. In the immediate vicinity of Sal- 
combe, there are two beautifully situated villas, Woodville and the 
Moult. At the former, under the shelter of a wooded hill, the 
American aloe has twice flowered in the open air, and with a degree 
of luxuriance almost equaling that which it displays in a tropical 
climate. The orange and lemon tree, also, thrive here, and ripen 
their fruit in the open air; the only protection they require during 
the winter, being that afforded by a covering of straw mat. These 
trees exhibit a degree of luxuriance and vigour, which I have seen 
in no other part of England, under the same circumstances. The 
olive tree has also occasionally produced fruit in this place. 

TORQ.UAY. 

The general character of the climate of the Southwestern Coast, 
is soft and humid. Torquay is certainly drier than the other places, 
and almost entirely free from fogs. This drier state of the atmo- 
sphere probably arises, in part from the limestone rocks, which are 



CLIMATES OF ENGLAND. 77 

confined to the neighbourhood of this place, and partly from its 
position between two streams, the Dart and the Teign, by which 
the rain is in some degree attracted. Torquay is in a great measure 
protected from northeast winds, the great evil of our spring climate. 
It is likewise well sheltered from the northwest. This protection 
from winds, extends also over a very considerable tract of country, 
abounding in every variety of landscape, in which the invalid may 
find at all times a sheltered spot for exercise either on foot or horse- 
back. The beauty of the country around Torquay, and the extent 
to which it is sheltered from all winds, is an advantage which it 
possesses over all the other places in this district, and one of great 
importance to the invalid. It possesses all the advantages of the 
southwestern climate in the highest degree. 1 

The village of Tor, situated immediately behind, and on the 
high ground above Torquay, has been mentioned as a favourable 
residence for invalids. It is. however, considerably colder, and less 
protected from northerly winds than the latter place, and is also 
said to be damper. Just beyond Tor is the little vale of Upton, 
which affords one of the most eligible situations on this coast for 
establishing a Madeira village; being protected from southerly as 
well as northerly winds. Were houses built along the base of the 
hills, which bound this little vale, and the intervening space entirely 
laid out in open pleasure grounds for exercise, Upton would, I be- 
lieve, form one of the most favourable winter residences for invalids 
in Devonshire. 

DAWLISH. 

Of the places on this coast, frequented by invalids during the 
winter, Dawlish appears to me to deserve the preference, after Tor- 
quay. Although less dry than the latter place, it is perhaps drier 
than the other parts of the coast. Dawlish is well protected from 
northerly winds, and also from the violence of the southwesterly 
gales. It is less protected from east winds, and this is more espe- 
cially the case with the part of the town situated near the beach ; 
indeed, this is much exposed to easterly winds. The part more 
distant from the sea is better protected; and there are also some 
well sheltered walks in this quarter. But Dawlish is altogether 
upon a small scale, and its confined situation must. I should think, 
render the air close and somewhat oppressive to many invalids, in 
calm, mild weather. 

EXMOUTH— SALTERTON. 

Part of Exmouth stands high, and is exposed to almost every 
wind, more especially to the southwesterly gales. The lower parts 

1 For a full and interesting account of the country the reader is referred to 
the Panorama of Torquay, &c. by Octavian Blew'it, Esq. 



78 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

of the town are protected from these, and, in a considerable degree 
also, from northerly winds. The situation of this part of the town, 
with respect to the river, exposes it, however, to occasional damp, 
as it did formerly to inundations from the sea in severe storms, with 
high tides. This latter inconvenience has been lately obviated by 
means of an embankment, which excludes the sea, and has thus 
allowed about sixty acres of what were formerly banks of mud to 
be converted into green meadows. There is here also a want of 
sheltered ground for exercise, and the place altogether does not ap- 
pear to possess great advantages as a winter residence for delicate 
invalids, more especially for those labouring under pulmonary 
affections. Exmouth is, however, a healthy place ; and 1 may 
remark here, that, notwithstanding the whole of this coast is rather 
humid, agues are almost unknown, as far as I could learn. A little 
way in the interior, they are not uncommon. Although Exmouth 
is not well suited for persons with delicate chests, other invalids 
often experience great benefit from a residence there, more particu- 
larly on the Beacon Hill, the most elevated and finest situation in 
the place ; and which, as some compensation for the bufTetings of 
the southwest gales, commands one of the most magnificent views 
in Devonshire. Along the southern base of this hill, there is also 
a road of considerable extent, protected from north and northeast 
winds, and well suited for exercise during the prevalence of these. 
Salterton. — This village, about four miles to the eastward of 
Exmouth, presents advantages in point of situation which render 
it preferable to the latter place as a winter abode for the invalid. It 
stands in a small open valley on the sea shore, well protected from 
winds, — particularly northerly winds. 

SIDMOUTH. 

This place is situated on the sea beach, at the mouth of an open 
valley, through which the little river Sid runs ; and would be fully 
exposed to northerly winds from the mountains, whence this stream 
takes its rise, but for the profusion of lofty and luxuriant elms and 
other trees, which shelter it partially in that quarter. Some of the 
houses at a little distance from the sea-beach are tolerably well pro- 
tected from northerly winds ; whilst Peak Hill and Salcombe Hill 
give protection in a considerable degree from westerly and easterly 
winds. Sidmouth seems well calculated for a summer and autumn 
bathing place ; and, in the more sheltered situations mentioned, the 
invalid may find a suitable abode during the winter. The climate 
is damp, and in November, is subject to sea-fogs, which is also said 
to be the case with Exmouth. 

In one or other of these places, the invalid may obtain all the 
benefit which a residence during the winter on the South Coast of 
Devon affords. 

The influence of the southwestern climate on disease may be 
anticipated, in a great degree, from its physical characters, which 



CLIMATES OF ENGLAND. 79 

we have shown to be mild but rather humid, consequently soothing 
but rather relaxing. In one class of complaints, it is, therefore, 
calculated to prove decidedly beneficial, — in another, of an opposite 
character, equally injurious. 

Pulmonary diseases are those in which the climate has been con- 
sidered especially beneficial. But as there is considerable variety 
in the character of the different diseases to which the lungs are 
liable, as well as in that of the different constitutions in which they 
occur, so will the benefit to be derived from this climate depend 
upon its being applied to the proper cases. In chronic inflammatory 
affections of the throat, trachea and bronchi, attended with a dry 
cough, or with little expectoration, decided benefit may be expected. 
But when there exists in such cases a relaxed state of the mucous 
surfaces with copious expectorations, especially when occurring in 
a languid and relaxed constitution, the disease is more likely to be 
aggravated than diminished by a residence on this coast. From 
this statement will be understood the character of the more serious 
diseases of the chest, which are likely to be relieved by this climate. 

In gastritic dyspepsia, it is serviceable ; likewise in dysmenorrhoea, 
and the various nervous symptoms consequent upon it. On the 
other hand, this climate certainly exerts an unfavourable influence 
on all nervous complaints arising from relaxation or want of tone of 
the nervous system ; on persons subject to nervous headaches ; and 
in the purer forms of atonic dyspepsia, more especially when accom- 
panied with a languid, relaxed state of constitution. Indeed, this 
form of dyspepsia is one of the most common complaints among the 
inhabitants of the coast; and it frequently happens that persons, 
who have come from a colder and more bracing part of the country 
to reside here, suffer much from this disease. 

This climate will be found no less unfavourable to persons sub- 
ject to menorrhagia and leucorrhoea, and in all diseases of the 
mucous membranes, attended with a relaxed state of the system, or 
with much discharge from the affected organs. In recommending 
a residence on this coast to invalids, it is absolutely necessary to 
attend to these distinctions, respecting the nature of their diseases, 
and the character of their constitutions, otherwise frequent disap- 
pointments must be the consequence. 

What maybe the real estimation in which the climate of Devon- 
shire ought to be held in consumptive complaints, and what may 
be its absolute effect upon these, I have much difficulty in saying: 
but this much I may venture to advance, that as the invalid will be 
exposed to less rigorous cold, and for a shorter season, — will have 
more hours of fine weather, and, consequently, more exercise in the 
open air, — he gives himself a better chance by passing the winter 
here, than in the more northern parts of the island. To compare 
it, also, in this respect, with the milder climates of the South of 
Europe, is no easy task. In the south, the invalid has finer days, 
a drier air, and more constant weather ; but the transitions of tem- 
perature, though less frequent, are more considerable. In the 



80 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

nights, I believe, invalids are often exposed to severer cold than 
here ; and this arises partly from the great range of temperature, 
and partly from the imperfect manner they are protected from the 
cold of night, by the bad arrangement of the houses, chimnies, &c. 
To afford an opportunity of judging of the proper value of this last 
circumstance, I subjoin a comparison of temperature in-doors and 
out-of-doors, from observations made by the same invalid (a correct 
and careful observer) at Nice and Torquay. 1 

From the soft nature of the climate of this coast, and the relax- 
ing and enervating effects which a long residence on it is liable to 
produce on many constitutions, invalids who mean to reside here 
during several winters, should leave it in the summer, and seek a 
drier and more bracing air. Such as are unwilling, or unable, to 
undertake a long journey, should retire to some of the drier and 
more elevated places at a little distance from the coast. Among 
these, Chudleigh deserves to be particularly noticed. It is finely 
situated on a ridge of limestone rock, beyond the range of the Hal- 
don hills, and about five miles from the coast, and is esteemed one 
of the driest and most healthy sites in this part of the country. A 
more inland situation, and, from its vicinity to Dartmoor, possessing 
a still more bracing air than Chudleigh, is Moreton Hamstead ; and 
this place, if suitable accommodations were to be found, would be a 
good summer quarter for invalids under the circumstances alluded 
to. Ilfracombe and Linton, on the northern coast of Devon, and 
other places in that beautiful and romantic region, afford excellent 
summer residences for some invalids. One objection to such a 
migration, which formerly existed in the badness of the roads, is 
now remedied by the formation of a new level line of road from 
Exeter to Barnstaple and Ilfracombe. 

There is as marked a difference between the summer climate of 
North and South Devon, as there is between the cast of their scenery; 
the air of the former being keen and bracing, and its features roman- 
tic and picturesque, while in the latter, the rich softness of the land- 
scape harmonises with the soft and soothing qualities of the climate. 

CLIMATE OF CORNWALL. 

The climate of the South Coast of Cornwall, in its general cha- 
racters, as also in its influence on disease, resembles closely that of 
the South Coast of Devon, and has also long been resorted to by 
pulmonary invalids. 

PENZANCE. 

Penzance, as the chief residence of invalids in Cornwall during 
the winter, claims a particular notice; it is situated on the shore of 
the beautiful Mounts- Bay, about ten miles from the extreme western 

1 Appendix, 



CLIMATES OF ENGLAND. 81 

point of England, termed the Land's-end. Although situated on the 
shore of a bay surrounded by high land, Penzance can hardly be 
said to be sheltered from any wind; it therefore exhibits, in its 
meteorological results, the common features of the district in which 
it lies. Dr. Forbes was the first to point out the character of this 
climate ; and it would have spared me much trouble and time, had 
I had the facility afforded me, in inquiring into other climates, for 
which we are indebted to Dr. Forbes in regard to this. A few such 
analyses, as his " Observations" present, would soon make the pro- 
blem of the climate of this country, as regards all useful purposes, 
cease to be a desideratum. 1 

The mean annual temperature of Penzance is 52°.16, being only 
1°.77 above that of London, But the temperature is very differently 
distributed over the year at the two places. Although Penzance is 
only a degree and a half warmer than London for the whole year, 
it is 55°"warmer in winter; 2° colder in summer; scarcely 1° 
warmer in the spring; and only about 2^° warmer in the autumn. 

As regards the temperature of the different months, relatively 
with London, the greatest difference occurs in the following order, 
— December, January, November and February. In April, the 
difference is reduced to half a degree ; in May, Penzance is 1° and 
in July, 2k° colder than in London ; and the temperature does not 
again rise above that of London until the month of October. So 
that were one to give a graphical term of expression for the pro- 
gression of the mean temperature of the two places through the 
year, that of London would more resemble an ellipsis, and "that of 
Penzance the more equal figure of a circle. This will be aptly 
illustrated by observing, that the difference between the mean tem- 
perature of the warmest and coldest months in London is 26°, 
while at Penzance it is only 18°; and that, whilst in London the 
mean difference of the temperature of successive months is 4°.36, it 
is only 3° at Penzance. On examining the progression of tempera- 
ture for the twenty-four hours at these two places, we find that, in 
winter, it is during the night that the greater part of this difference 
of temperature occurs; Penzance being nearly, on an average, six 
degrees and a half warmer than London during the night ; and 
only little more than three degrees warmer during the day. But 
this equal distribution of heat throughout the year at Penzance, 
which we have compared so advantageously with that of London, 
is still more striking when compared with that of the South of 
Europe. Madeira and the Azores are the only climates which we 
have examined that are superior to Penzance in this quality. 

The same remarkable equality in the distribution of temperature 
during the year at Penzance, holds equally true for the day ; 2 and, 

'Observations on the Climate of Penzance and the District of the Land's- 
end. By John Forbes, M. D. 

2 Thus in the winter of 1827-8, the mean daily range at Penzance was 
7°.50; at London, at Gosport, Torquay, and Nice, it was 12°, 10°, 11°, and 
11° respectively. 

1 — f 6 dark 



82 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

indeed, I may observe generally, that the progression of tempera- 
ture for the year and the day, are faithful types of each other. I 
find, on comparing the months for a series of years, that the daily 
range at Penzance is little more than half that of the South of 
Europe; but in this quality, it also falls short of Madeira. And 
here is a proper opportunity of remarking, that although in mean 
temperature for the whole twenty-four hours, Penzance is consi- 
derably lower than that of the South of Europe, yet that during the 
night, through the winter, its extreme minimum temperature sel- 
dom is so low. It is during the day, only, that the South of Europe, 
as far as regards temperature simply, possesses a superiority. Thus, 
in winter, at seven o'clock in the morning, there is little difference 
between Rome and Penzance, but at two o'clock in the afternoon, 
there is nearly the difference of 7°. Indeed the whole advantage of 
Penzance, as compared with the South of Europe, appears to occur 
in the winter and during the night. 

In the duration of the same temperature, as shown by the mean 
variation of successive days, the climate of Penzance excels all the 
northern climates, and nearly equals Rome and Nice in this respect. 

As will have been observed, Penzance loses, in the spring, its 
superiority of climate. In April and May, it appears decidedly in- 
ferior to the more sheltered spots on the South Coast of Devon, 
and to Undercliff, and very much so to the Southwest of France. 
For instance, at Pan, the mean temperature during the winter is 
nearly 3° below that of Penzance, while during the spring it is 5° 
above it. 

In the other elements of climate, this district has less peculiar 
advantages. There falls at Penzance about twice as much rain as 
at London. The number of days on which rain falls, does not, 
however, seem in proportion to the quantity of fluid precipitated. 
Mr. Giddy makes the average number of wet days, during seven 
years, 177.3, and he particularly states, that under this head he 
comprehends " rainy, showery, and misty days, — in short, all days 
on which there is any fall whatever, even a slight shower." The 
average number of wet days at London is 178, being almost pre- 
cisely the same as that recorded by Mr. Giddy for Penzance. Of 
the much greater humidity of the atmosphere in Cornwall, how- 
ever, there can be no doubt. The testimony of Dr. Forbes, who 
had ample means of forming a correct judgment, is very strong on 
this point. Another of the disadvantages of the climate of the south- 
western extremity of our island, is its liability to violent and fre- 
quent gales of wind, and of this disadvantage Penzance appears to 
partake largely. 

The effects of the southerly winds is to raise the temperature 
greatly, especially during the night. " During the prevalence of 
the south or southwest gales," says Dr. Forbes, " there is very little 
difference of temperature between the day and night, as proved by 
the register thermometer. Sometimes there is no difference what- 
ever; and very commonly the minimum of the night is not more 



CLIMATES OF ENGLAND. 83 

than 3- or 4° below the maximum of the day. This shows how 
very completely the influence of the sun is excluded by the dense 
vapour with which the air is loaded: and during these our moist 
siroccos, we may say. without any metaphor, that we are breathing" 
the breezes of a climate milder than our own. When these south 
and southwest winds, so prevalent in winter, are very gentle, the 
is often clear for many days together. On these occasions, the 
warmth and softness oi the air are truly delightful : and when 
taken in conjunction with the beautiful scenery around Penzance, — 
the calm blue bay. — the gay green meadows. — the myrtles, and 
other exotic plants common in our shrubberies. — one is almost 
tempted to forget that it is winter landscape that he is contem- 
plating." 1 

It is principally in consequence of its exposure to the northeast 
during the spring months, that Penzance is absolutely colder than 
the coast ot Devonshire, or even the neighbourhood of Bristol, 
daring this season. This circumstance of exposure to. or shelter 
from cold winds, constitutes the principal cause of the difference of 
different places, in the same line of climate, in point of warmth as 
experienced by man ; for the influence of temperature on the living 
body is indicated much more accurately by our sensation than by 
lermometer. Unless, therefore, the indications of the thermo- 
meter are corrected by observing the winds, we shall form very 
erroneous ideas of the climate of many places. 

The only other place in this district that deserves particular 
notice is Falmouth, including: the neighbouring- village of Flush- 
ing. The winter temperature of Falmouth (which lies about thirty 
miles to the east of Penzance' is a trifle lower than that of the latter 
place, but the general qualities of its climate are nearly the same. 
In one respect, indeed, the village of Flushing, which is situated 
on the east side of the river Fal, ; Falmouth being on the west, has 
the advantage of Penzance, being much better sheltered from the 
east winds by the hills which rise immediately above it. and if it 
possessed good accommodations, erected in the best situation, this 
village would form a residence for invalids, during the spring- 
months, superior to Penzance. Like many other places, however, 
favourably circumstanced as to shelter by hills, the local climate of 
Flushing is much too limited, from a deficiency of protected ground 
for exercise. 

The disadvantages which attach to the climate of the Land's-end 
generally, in point of humidity and exposure to winds, are such, as 
in a great measure to neutralise the superiority which it possesses 
over the other climates of England in mildness and equability of 
temperature. In its general characters, this climate resembles so 
closely that of the south coast of Devonshire, that the remarks 
already made on the influence of the latter on disease, apply nearly 
to it. The climate of the southwest of Cornwall is still more relax- 

1 Op. citat. 



84 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

ing than that of the south of Devon. Disorders, commonly termed 
nervous and stomach complaints, are unusually frequent among 
the lower classes. Diseases of the osseous system, — of the spine 
and large joints (mostly of a scrofulous character,) are also very 
common. Although not a strong race of people, the inhabitants of 
this district are, however, long lived. 

Regarding the influence of this climate on consumption, we have 
the testimony of Dr. Forbes, founded on ample experience, that little 
is to be expected from it ; but we ought to admit, at the same time, 
that, in this respect, it but shares the opprobrium with every other 
climate, in the advanced stages of that disease. " In a good many 
cases, however, of chronic bronchitis, simulating phthisis, the health 
was greatly improved, and in some it was completely restored, from 
a state of great debility and seeming danger. In a few cases, also, 
of young persons who accompanied their diseased relatives, and in 
whom the hereditary predisposition was strongly marked, if there 
was not already evidence of nascent tubercles,— a great and striking 
improvement in the general health and strength followed within a 
short period after their arrival, and seemed fairly attributable to the 
combined influence of change of air, scene and habits." 1 

The consumptive cases in which the soft humid atmosphere of 
this place is likely to prove beneficial, are those in which the dis- 
ease is accompanied with an irritated state of the mucous membrane 
of the lungs, producing a dry cough, or one with little expectoration. 

In idiopathic tracheal and bronchial diseases of the same charac- 
ter, whether complicated with asthma, or otherwise, and also in 
certain pure cases of the latter disease, it is likely to be very bene- 
ficial. When, on the contrary, there exists a relaxed state of the 
system, or a disposition to copious secretion from the bronchial 
membrane, whether idiopathic, or symptomatic of a tuberculous 
state of the lungs, or where hagmoptysis has occurred, I believe the 
climate of the Land's-end will generally prove injurious. 

As a summer residence for invalids, and also as a residence dur- 
ing the whole year, the district of the Land's-end is, perhaps, equal 
to the coast of Devonshire. In the winter, however, and still more 
in the spring, the latter will, I believe, in most cases deserve a pre- 
ference. If Penzance is somewhat warmer and more equable in its 
temperature, it is more humid and more exposed to storms during 
the winter, while it is rather colder, and less protected from the 
northeast winds during the spring. Aged invalids, with whom, in 
general, a soft climate agrees, and to whom even a moderate degree 
of humidity is not objectionable, might more particularly derive 
benefit by residing during the whole year at Penzance. The great 
mildness of the winter would enable them to be much in the open 
air, and they would have less to dread from the coldness of the 
nights than in any other part of England. 

'Dr. Forbes's translation of Laennec's Treatise on Diseases of the Chest. 
Note by translator, 3d Edit. p. 73. 



CLIMATES OP ENGLAND. 85 

The country around Penzance is healthy, and affords a great 
variety of excellent rides and drives. Accommodations for invalids 
are numerous; and being a sea-port, the place affords convenience 
for water exercise during the summer. Invalids who have passed 
the winter at Penzance, and whose complaints are likely to be 
aggravated by the spring winds, might remove to Flushing or 
Fowey at that season ; and some might even go to Clifton with 
advantage. 1 

WEST OP ENGLAND. 

The mean temperature of the Western Group of climates dur- 
ing the winter is rather lower than that of the South Coast, but in 
March and April rises a little higher. Bath and Bristol, during the 
months of November and December, are nearly 3° warmer than 
London. In January and February they do not average 1° warmer ; 
in March, Bath and Cheltenham are rather colder than London, but 
Bristol continues from one to two degrees warmer during March as 
well as April. On comparing Penzance with this tract, we find 
only 1° of difference in the mean annual temperature. In winter, 
however, Penzance is 4° warmer ; but in the spring and summer 
it is somewhat colder. The distribution of heat throughout 
the year, is more unequal in this district than in the others ; the 
difference of the warmest and coldest months being 28°, while it is 
only 26° at London, 21° at Gosport, 20° at Torquay, and 18° at 
Penzance. We find, also, that the range of temperature for the day 
and the month is considerably more than on the Southern and 
Southwestern coasts, and the Land's-end ; the minimum term of 
temperature being from 3° to 5°, and even to 6° lower than at some 
of these places. In steadiness of temperature from day to day, it 
nearly corresponds with the South Coast, but is inferior to that of 
South-Devon, and considerably so to Penzance. 

CLIFTON. 

In this tract of country the vale* of Bristol appears to be the 
mildest and most sheltered spot. The climate, during the winter, 
is mitigated by the vicinity of the great western ocean, while its 
landlocked situation protects it from the winds of that quarter. 
To those from the southeast it is fully open. The fall of rain in 
this district is less than from its western position might have been 
expected. The mountain ranges which flank the country border- 
ing the Bristol channel, — those of Wales on the north, and those of 

*For much interesting information respecting the natural history and anti- 
quities of this district, I refer the reader to Dr. Forbes's tract, already referred 
to, and to his more recent and admirable essay on the Medical Topography 
of the Lands-end, in the Provincial Medical Transactions, vol. ii. ; also to 
an amusing little work, entitled, " A Guide to Penzance and the Lands- 
end," written, it is said, by an eminent physician now resident in London. 



86 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

Cornwall and Devonshire on the south, by modifying the course of 
the clouds from the Atlantic, appear to diminish thefall of rain in 
the intervening space. There is reason to believe also that this is 
even less at Bristol than the average of the surrounding district, a 
circumstance which may be accounted for, partly by its protection 
from westerly winds, and partly from its position with respect to 
the course of the Severn and its extensive estuary ; from the nearest 
part of which Bristol is distant about five miles, and is, at the same 
time, completely shut out from it by the intervening high land. 
But however the circumstance may be explained, the fall of rain is 
absolutely less here than in Devonshire and Cornwall, and much 
the same as that on the south coast. 1 

The surrounding hills are composed chiefly of limestone, and 
this circumstance tends further to diminish the humidity of the 
atmosphere. 

Clifton and its immediate neighbourhood, afford a considerable 
variety in point of shelter and elevation of site. The town is built 
on the southern declivity of a hill, at the bottom of which is situated 
the Bristol Hotwells. Here, and in the lower parts of Clifton, the 
most sheltered situations are to be found. And, accordingly, con- 
sumptive and other delicate invalids should seek the more protected 
spots in this quarter during the winter: while those requiring less 
shelter may reside on the higher but still sheltered parts of Clifton. 
The crescentic forms of the buildings in this place are singularly 
well adapted to the situation, as they afford protection to so many 
terraces, well suited for exercise during the prevalence of northerly 
winds. In the lower grounds there are also some sheltered walks, 
and towards the park several rides and foot paths which are tolerably 
defended from northerly winds. But, in this respect, Clifton, during 
the cold season, does not afford great variety. When, however, the 
weather is sufficiently mild to admit of the invalid going to some 
little distance from home, few places present more beauty or variety. 
The whole parish of Clifton is indeed well described by the late Dr. 
Chisholm, as " a beautiful and romantic assemblage of woods, rock, 
water, pasture and down. It seems indeed singularly well adapted 
to the maintenance of health ; the soil resting on immense beds of 
limestone rock, exposed to the southerly and westerly winds, for 
nearly three fourths of the year ; with an atmosphere elastic, vivify- 
ing — not humid." 2 The surrounding country is healthy, being free 

1 The average fall of rain for six years at Bristol, as given by Dr. Cole, is 
31 inches. Penzance 44. London 25. There is reason to believe, however, 
that 31 inches is above the average fall. Dr. Carrick makes the mean often 
years, 1801 to 1810, only 24 inches; and the accuracy of Dr. Carrick's ob- 
servation is supported by those of Col. Cupper, which give a mean of 23.76 
for eight years (1800 to 1S07) at Cardiff.— See his Meteorological and Mis- 
cellaneous Tracts. 

* See an excellent paper, by this amiable and enlightened physician, on 
the Statistical Pathology of Bristol and of Clifton, in the Ed. Med. and 
Surg. Journal, vol. xiii. 1817. 



CLIMATES OF ENGLAND. 87 

from every thing like marsh. Dr. C. informs us that in the list of 
diseases admitted, during four years, into the Clifton dispensary, 
only one case of intermittent fever appeared, and that one was from 
the fenny district near Congresbury, about twelve miles to the west- 
ward of Clifton. 

As far, then, as we are enabled to judge respecting this climate, 
from the obvious local advantages which it possesses, in point of 
shelter and aspect, and from the evidence afforded by meteorological 
registers, the vicinity of Bristol and Clifton appears to be the mildest 
and driest climate in the west of England, and consequently the best 
winter residence, in that part of the country, for invalids. 

Compared with the South and Southwest Coasts, the spring is 
the period of the year during which this climate appears to the 
greatest advantage. This season, as we have already seen, is 
warmer here than on the South Coast, (with the exception of 
UnderclifT,) whilst it is equal to that of the warmer parts of the 
Southwest Coast. When the climate of Clifton is compared more 
closely with that of Devonshire, it may be characterised as drier 
and more bracing than the latter, and as more exciting to most 
consumptive patients, and to those labouring under irritable affec- 
tions of the bronchial membrane. For such cases, the softer and 
more humid air of Devon will be found more soothing ; while for 
invalids, whose constitutions have suffered from long continued 
derangement of the digestive organs, or a congested state of the 
mucous membranes with copious secretion, and also for young 
scrofulous persons, and those of relaxed habits of body generally, 
Clifton will prove a preferable climate. And this gives me an 
opportunity of repeating, that in comparing climates together, as 
regards their influence on diseases, the constitution of the patient, 
and the particular nature of the disease, must be taken fully into 
consideration in deciding on their respective merits in each indivi- 
dual case. 

But the advantages of Clifton, as a residence for the invalid, are 
not limited to the winter ; it affords also a very favourable summer 
climate. Indeed, the higher situations on Clifton Hill are as eligible 
during the latter season, as the lower and more sheltered parts are 
during the former. A more complete change of air than this, how- 
ever, will in general be advisable, when there are not material 
objections to traveling. The interior parts of the same district, as 
about Cheltenham, and, still better, the hills of Malvern, one of the 
coolest and most healthy summer residences in England, will suit 
many invalids. For young persons of a scrofulous constitution, 
the summer climate of Malvern is admirably suited. Others may 
pass the summer with more benefit among the mountains of Wales ; 
and in cases in which a course of goat's whey promises advantage, 
this will be the preferable plan. Abergavenny is, I believe, the 
most esteemed station for this purpose. Several healthy and con- 
venient places present themselves on the opposite coast of Wales, 
as at Aberystwith, Tenby, Barmouth, &c, which form good resi- 



SO CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

dences during the latter part of summer and the autumn, more 
especially when sea-air or sea-bathing is indicated. These places, 
from the accommodation of steam vessels, may be reached by a 
voyage of a few hours ; a circumstance of material consequence to 
the invalid unable to bear the fatigue of a journey by land. 

In its local advantages and geographical position, therefore, 
Clifton affords peculiar advantages as a residence for a large class 
of invalids. Within its own limits it affords a sheltered winter and 
spring, and an open airy summer and autumn residence; whilst it 
is surrounded by numerous places of convenient and agreeable resort 
in the fine season, suited to the various classes of persons who may 
seek its shelter during the winter. 

Bristol Hot-well. — I must not quit Bristol without some notice 
of the once celebrated spring which formerly, indeed, was the chief 
object of attraction at this place for invalids. The virtues of this 
source were then as much overrated as they appear now to be 
underrated. Yet I believe many of the valetudinarians, who fre- 
quent Clifton on account of its climate, might derive benefit from 
the use of this water. 

According to Dr. Carriclrs analysis, made in 1797, it appears to 
be a very pure water, having at its natural temperature of 76°, a 
specific gravity of only 1.00077. It contains a very small propor- 
tion of lime, soda, and magnesia, in combination with the carbonic, 
sulphuric, and muriatic acids ; but a considerable proportion of free 
carbonic acid, and a little atmospheric air. The presence of the 
fixed air, together with its temperature, renders this water grateful 
to the stomachs of most persons. Dr. Saunders has well charac- 
terised it as a pure, warm, slightly acidulated water; and even as 
such it will, I have no doubt, be found useful in many cases of dys- 
peysia. Like some other natural warm waters, it is said to be very 
efficacious in allaying the thirst which accompanies the paroxysms 
of symptomatic fever ; and Dr. Riley, of Clifton, informs me that 
he has found it of essential service in several cases of diabetes. 
But it is chiefly in a deranged state of the digestive organs that it 
is indicated. In the nervous forms of dyspepsia, when the stomach 
is in a languid state, and does not tolerate cold fluids, it will prove 
useful. During the spring, several tumblers drunk before breakfast, 
with exercise on foot or on horseback, according to circumstances, 
will, id many cases, greatly favour the effects of the climate, in 
restoring the energy of the digestive organs, and thereby improving 
the general health. It may be advantageously used also as a com- 
mon drink at meals. But I venture these opinions, rather on the 
experience of others than my own. 

ISLAND OF BUTE. 

This island lies in the Frith of Clyde, about eighteen miles below 
Greenock, and is almost surrounded by the Jofty hills of the opposite 
coast. It is eighteen miles in length from east to west, and from four 



CLIMATES OF ENGLAND. 89 

to six miles in breadth. The highest parts of it are not more than 
140 feet above the level of the sea. 

The temperature of Bute never falls low during winter, nor rises 
high in summer, so that its yearly range is comparatively limited — 
under 40°, which is at least 15° less than what it is at Glasgow. 
The temperature will more frequently rise above 75° at Glasgow, 
than above 70° at Rothsay in Bute ; and oftener sink below 20° at 
Glasgow, than below 30° at Rothsay. 

Snow, when it does chance to fall, seldom lies longer than a few 
hours. During severe and long-continued frost on the mainland, 
and when the surrounding hills there are for many weeks covered 
with snow, a little may be seen on the higher parts of Bute ; but 
even then the temperature on the lower grounds is rarely under 
2S C during the night, and 34° during the day. In the whole course 
of twelve years of the most careful and accurate hourly observations, 
the thermometer never fell lower in Bute than 20° above zero of 
Fahrenheit's scale, and on three occasions only was it nearly so 
low. On one of these the thermometer in the Botanic Gardens at 
Glasgow, indicated 5° below zero. This was indeed the greatest 
difference observed during these twelve years; but in very severe 
frost the difference was often from 10 to 15 degrees. In ordinary 
weather there is no marked difference of temperature ; but in very 
hot weather, the thermometer in Bute does not rise so high by 
several degrees as on the mainland. 

Every part of Bute is not equally sheltered and mild during 
winter. The eastern is much milder than the northern coast, 
owing to its being in some measure protected from the influence of 
the north wind. 

The climate of this island may be characterised as mild and 
equable but rather humid. It resembles in character that of the 
southwest of England, and France, and of the Channel Islands, 
though considerably less warm than any of these. As a winter 
residence for invalids, it holds out considerable advantages to that 
class only for whom a soft, equable, but rather humid atmosphere 
is indicated. 

The observations which have been made on the character of 
the diseases benefited by the climates alluded to, apply to that of 
Bute. 1 

COVE. 
Cork Harbour, on the southern shore of Ireland, is an ovoid 

1 We are indebted to Mr. Thorn for the most complete account of the cli- 
mate of Bute that was perhaps ever kept of any place. In the Appendix 
will be found, a meteorological table, the results of twelve years' hourly 
observations, which Mr. Thom had the kindness to draw up at my request. 
It is to be hoped that he may publish the whole of the data from which this 
table is calculated, as they constitute the most complete series of meteorolo- 
gical observations perhaps ever made, and at this moment, when the atten- 
tion of men of science is particularly directed to the subject of meteorology, 
their publication is most desiiable. 



90 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

basin, above seven miles by five, surrounded by the mainland. 
Within, and on the northern side of this harbour, lies the island of 
Cove ; the extreme length of which, from east to west, is seven, 
and its greatest breadth, three and a half miles. The island con- 
sists of two hills, from two to three hundred feet high, running 
from east to west ; the northern ridge forming the chief body of the 
island. The town of Cove, containing about eight thousand inha- 
bitants, is built on the southern acclivity of the southern hill. It 
consists of terraces rising from within a few feet of elevation above 
water mark to a considerable height, and in a crescentic form, 
facing the south. From its position and configuration, the town is 
sheltered from northern winds, on the one hand, and, on the other, 
is open to the full influence of the sun. 

The accommodations for invalids are good, and the walks and 
drives well sheltered. The facilities of intercourse between Cove 
and other places are frequent, and are daily increasing. 

The following observations, by Dr. Scott, relate to the lower part 
of the town of Cove. 

The mean annual temperature, deduced from the mean observa- 
tions of the three years from September, 1834, to August, 1837, 
and made up of the mean maximum 56°.7, and mean minimum 
46°. 5, amounts to 51°.6. The mean dew-point 46°. The fall of 
rain 33.299 inches, and the evaporation, calculated from the mean 
temperature and dew-point, about 25.643 inches. 

Fall of rain in winter 10.565 inches, and number of rainy days 
35. In spring, the fall is 4.06, and the number of rainy days ^8. 

The number of days of frost and snow, in winter and spring, is 
very inconsiderable. Snow seldom lies longer than a few hours. 

The duration of each wind, during the three years, was : — from 
the south, 96 days; southwest, 222; west, 159; northwest, 213; 
north, 132; northeast, 84; east, 78 ; and southeast, 111. 1 

From these observations, and the comparisons given in the 
Tables on English climates, Cove appears to be one of the mildest 
climates in Great Britain ; being inferior in point of temperature to 
Penzance only, during the winter months, and to the same place 
and Torquay only during the spring. In point of dryness, Cove 
does not stand so high in the table of comparison. The winter is, 
comparatively with the other places, the season during which the 
greatest quantity of rain falls. 

In its general characters of climate, and the influence of this on 
disease, Cove corresponds with the southwest of England, and 
other similar climates. 

The subjoined tables exhibit the temperature, the fall of rain, 
and the number of rainy days during the winter and spring, at the 
principal places in Britain resorted to by invalids. 

1 Dr. Scott, on the Medical Topography of Cove. — Dublin Journal of 
Medical Science, vol. xiii. To this elaborate and excellent paper I am in- 
debted for the information contained in the above article on Cove. 



CLIMATES OF ENGLAND. 



91 



COMPARATIVE TEMPERATURE OF PLACES TAKEN BY 
REGISTER THERMOMETERS. 



Mean Temp, of 1 f^ 8 " „°! 1 Number of years' Observation from which 
Places. | . . _ . ,h ? ' *° tfl e Means are taken, 
j Winter | Spring | seasons | 


London 


39.12 


48.76 


43.94 


Nineteen years. 


Hastings 


40.11 


45.77 


42.94 


For winter, five years, including 
severe winter of 1837-38; for 
spring, four years. 


Undercliff 


42.52 


48.83 


45.67 


For winter, six years, including se- 
vere winter of 1829-30. Spring, 
two years. 


Torquay 


39.83 


50.83 


45.33 


Two years, including severe winter 
of 1829-30. 


Penzanee 


44.03 


49.63 


46.83 


Ten years. 


Cove . . . 


43.90 


49.43 


46.66 


Three years. 


Bute . . . 


39.62 


46.66 


43.13 


Nineteen years. 



COMPARATIVE QUANTITIES OF RAIN CALCULATED IN 
INCHES. 



Places. | Mean quantity for 
| Winter. | Spring. 


No ofrainvdavs 1 Number of years' observation 
No. ot rainy day*. from which the Meang are 

Winter. | Spring. | taken* 


London 


5.85 


4.80 


48.0 


43.0 


Twenty years. 


Hastings 


7.44 


3.86 


38.2 


27.2 


For winter and spring, 3 
years, including the rainy 
seasons, 1838-9, 1839-40. 


Undercliff 


6.17 


3.83 


43.0 


19.5 


Three years, including the 
rainy seasons, 1838-9, 
1839-40. 


Penzance 


12.64 


9.35 


50.7 


40.6 


Twelve years. 


Cove . . . 


10.565 


4.06 


35.0 


28.0 


Three years. 


Bute . . . 


10.17 


7.21, 


44.7 


32.5 


Nineteen years. 



* The number of years' observations, from which the number of rainy days 
is deduced for London and Undercliff, is respectively ten and two. The 
number of years for the other places is as in the Table. 



92 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

In bringing to a conclusion this brief account of the warmer 
situations in our own country, it may be expected that I should 
apply the preceding observations on the physical characters of their 
climates, to the object of our researches, and say, what are the ad- 
vantages which these situations hold out generally to invalids, and 
what are the diseases in which they are respectively beneficial. 

The whole of these places, as we have seen, are considerably 
warmer during the winter and spring than England generally, and 
very much warmer than the colder parts of it. Indeed, as I have 
shown, and as a reference to the tables in the Appendix will fur- 
ther prove, there exists as much difference in regard to tempera- 
ture, and its distribution between the northern and southern parts 
of England, as between the latter and the south of Europe. Now 
as the influence of temperature on the living body is, in a great 
degree, relative, an inhabitant of one of the coldest parts of this 
country would, it is reasonable to believe, feel the influence of the 
climate of the south of England (as far, at least, as regards tem- 
perature) as much as an inhabitant of the latter would that of the 
south of Europe.' An invalid, therefore, from Scotland, or the 
north of England, will find, in the places above mentioned, a cli- 
mate, compared with his own, sufficiently mild to produce a bene- 
ficial influence on his health. Besides this, his opportunities of 
taking exercise in the open air will be much more frequent, and 
being exposed to a degree of cold less severe and of shorter continu- 
ance, he will avoid a constantly recurring cause of relapse. 

But it must be kept in mind, as has been before observed, that 
there are other circumstances connected with the adaptation of 
climate to disease which require attention, as well as temperature. 
The particular nature of the disease and of the patient's constitu- 
tion, and the character of the climate most suitable for these, will 
naturally be the first object of the physician's consideration ; but 
the nature of the climate in which the invalid has lived, ought also 
to be taken into account. This last circumstance, namely, the 
comparative influence of any particular climate on different indi- 
viduals, depending on the nature of that which they previously 
inhabited, has not, I believe, been sufficiently attended to : it de- 

1 The influence of relative temperature on organic life might be aptly 
illustrated by a reference to its very remarkable effects on plants ; and the 
influence of warmth, whether natural or artificial, in exciting or accelerating 
the vegetation of these, affords matter of reflection to the physician in esti- 
mating the effects of climate on man. It is, I believe, a general practice 
with gardeners in respect to plants, which they wish to force rapidly in the 
hot house, to keep them previously in as cold a temperature as they will 
bear. And it has been often proved, that a vine, accustomed to the tem- 
perature of the open air, will vegetate in winter, if transferred to the hot 
house, while a plant from the same stock, accustomed to the stove, will 
remain without any sign of budding. See Mr. Knight's Observations on 
the Method of Producing New and Early Fruit. — Transactions of the Hor- 
ticultural Society of London, vol. i. 



CLIMATES OF ENGLAND, 93 

serves, however the especial consideration of physicians when 
selecting a climate for their pati 

With respect to the merits of the milder parts of England in their 
influence on disease. I have already made a few remarks while 
treating - of particular places. As regards consumptive invalid] 
whom climate has been looked to as the great resource. I beg to 
refer the reader to the article on consumption. 

There is no one of the English climates, as far. at least, as our 

present knowledge of them extends, so much superior to the others, 

as to give it a claim to a decided preference in consumptive dis- 

The selection must, therefore, depend upon the nature cf 

the iodivid institution, and the character of disease. In cases 

in which a soft and rather humid air is known to agree, the coast 

res the preference ; and at the more sheltered parts ot the 

coast of Devon, as Torquay, and at Penzance. .erality of 

nts labouring under confirmed pulmonary disease, will find 

an air more soothing to the respiratory organs than at any other 

place frequented by invalids in our island. For invalids labouring 

under a relaxed state of the bronchial membrane, or of the system 

generally, or where a strong disposition to haemoptysis has shown 

itself, the drier and more bracing air ot Clifton wili agree better : 

and UnderclirT will prove a still more favourable residence. 

climate of Hastings may be considered as somewhat intermediate 

en that of Devonshire and Clifton ; less warm, but also kss 

relaxing than the former, it is about the same temperature, but less 

dry and bracing than the latter, and it is inferior to it as a spring 

climate. The air of Has: lias been already remarked is 

more essentially a sea-air than that ot any of these places f a 

circumstance which will have its due weight with the physician, 

when deciding upon a climate for his patient. 1 

On the other dis the chest, climate exerts a very ber.efi- 

cial influence. In the chronic inflammatory affections of the throat, 
trachea and bronchi, of the dry. irritable kind, or accompanied with 
little secretion or expectoration, the coast ot Devonshire affords a 
very favourable climate; likewise in dysmennorhoea. and in dry 
irritable cutaneous diseases. In diseases of the bronchial mem- 
brane, on the other hand, which are attended with copious expec- 
toration, or when there is a greatly relaxed state of the mucous 
membrane of the chest, with atonic dyspepsia, the climate of the 
southwest ot England is unfavourable : as it is in uterine disorders 
attended with copious discharges : in mencrrhagia. and in all dis- 
accompanied with a relaxed state of the system generally. It 
is difficult to find any place in our island well suited during the 
whole of the cold season, to that numerous class of bronchial dis- 
eases, where there is a greatly relaxed state of the mucous mem- 
branes, and yet a constant disposition to a more active degree of 
inflammatory disease. UnderclirT will be found one o( the best 

1 See article on consumption. 



94 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

climates for such patients, and Clifton also is a good climate. 
Brighton is a very favourable residence during the autumn and 
part of the winter, but after the month of February it is equally 
unfavourable. Persons labouring under bronchial disease in its 
less severe forms, who cannot absent themselves from London 
during the whole season, might pass the autumn at Brighton, re- 
main in town during the winter, and go to UnderclifTor Clifton for 
the spring mouths ; or should this be inconvenient, Chelsea, 
Brompton, and Kensington, afford sheltered spring situations. 

In the disordered states of the digestive organs, which not unfre- 
qaently lead to consumption, and in broken down constitutions, 
the genial influence of a mild climate is one of the most powerful 
means of relief which we possess, in those cases in which, from a 
loig deranged state of stomach, a sympathetic irritation has been 
excited in the bronchial membrane, and the person is liable to 
attacks of catarrh every spring, or is subject to habitual cough, 
greatly aggravated during that season, such a change is peculiarly 
beneficial. No class of invalids is, indeed, more susceptible of cold, 
or suffer more from it than dyspeptics, more especially nervous 
cyspeptics. But a low degree of temperature is not the only con- 
dition of the atmosphere which disagrees with persons suffering 
from stomach complaints. There are other circumstances in the 
nature of a climate, cognizable rather by their effects, than by the 
appreciable physical qualities of the air, which exert a powerful 
influence on their sensitive constitutions. Different forms of this 
disease also derive benefit from climates of a different character. 
With persons labouring under gastritic dyspepsia, the climate of 
Devonshire will agree, while it will decidedly disagree with those 
suffering from the atonic form of the disease. 1 In proportion, 
therefore, as the one or other of these conditions predominates, will 
this climate prove beneficial or the reverse; but I should scarcely 
consider a long residence in it advisable in any form of dyspepsia. 
Persons who have lived in a drier and more bracing air become, 
after a short residence on this coast, very sensible of the enervating 
and debilitating influence of the climate on their digestive organs. 
They feel a sense of distention or oppression in the region of the 
stomach, with a torpor of the whole system, after meals, indicative 
of laborious digestion. In the nervous forms of dyspepsia, Clifton 
will prove a much more favourable residence than any part of De- 
vonshire. Brighton, during the autumn and greater part of the 
winter, agrees admirably with this class of dyspeptics in general. 

Other situations are, no doubt, to be found in our island, besides 
those which I have noticed, capable of affording a favourable retreat 
to the invalid during our inclement season ; but I have thought it 
necessary to notice those places only, with the climates of which 
we are best acquainted. 

It is probable, that some may find my distinciions of climate too 

1 See article on disorders of the digestive organs. 



CLIMATES OF :N".AN?. 






minute and particular, and my directions not sufficient 
and absolute. To such I beg 10 observe, that I have drawn no dis- 
tinctions for which 1 have not data ; and that one of the principal 
objects of the second part of this work is to call the attention of 
the profession to these distinctions, the importance of which, in a 
remedial point of g :er than gei rally be 

Where my experience has allowed. I have pointed out the use and 
application of these distinctions : but when this has not been the 
case, I have preferred to leave the application of them to tutu re and 
more extensive observation; le> _ ring beyond what my pre- 

mises justify. I might, by a false cc value and 

importance of what I know to be true. 

Summer Residences. — After this :i the best winter cli- 

mates iu England, it may be expected that we some 

notice of our more salubrious summer r 

ver. it is not nece- ^o into detail, as then 

healthy situations to which our invalids may repair with 
duriug this season. In the selectL inter 

residence, the same circumstauces require attention, both as re- 
gards the character of the climate and the nature of the inv 
disease. Even during this season, the milder and w 
situations must be chosen for delie; 
while for the relaxed and enerv 
sibility, the bracing air of the higher and drier d 
more suitable. To a larsre class of invalids watering 

places offer a I ellent situati - >es in 

which sea-bathing is proper, t ence over the 

interior, especially during the latter part of the summer and au- 
tumn. Several of our in taring places, independently of 
the advantages to be obtained, in ma £>m the use of their 
mineral waters, afford good summer climates ; and. iudeed. some 
of them, more on this account than any other, have become places 
of fashionable resort. Among these v Malvern, 
Cheltenham, Leamington, Tunbridge Wells. Matlock, &c In 
general it will be advantageous to invalids who have resided 
during the summer at any of those places, to pass the autumn by 
the sea-side, as at some of the driest places on the south, or south- 
east coast. In the t number of cases in which t: 
borne without inconvenie ral changes, or ■ on of 
short journeys, will be more beneficial to most invalids than a resi- 
dence during the whole season in any one place. It is remarkable 
how such repeated changes, with frequent gentle exercise, espe- 
cially on horseback, renovate the constitution enfeebled t 
enable it to overcome many ehrouic affections, and contribute to 
the restoration of permanent health. But.. have oca 

recur to this subject. 



96 



CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 



THE CHANNEL ISLANDS. 

These islands are occasionally resorted to by invalids from this 
country, and. when the cases are properly selected, often with ad- 
vantage. 

Jersey is the largest of the Channel Islands, and that most fre- 
quented by invalids. It stretches from east to west, and averages 
nine miles in length, by five in breadth. From the north coast, 
which is steep and craggy, the island slopes to the south. It con- 
sists almost entirely of hill and dale, and abounds in wood and 
verdure. The ground is thickly hedged, and the pathways are 
bordered by double files of trees, planted on high embankments, 
interrupting the view from the highest carriage. The general 
character of the soil of Jersey is a deep, sandy loam, with a sub- 
soil of red loam or clay, based on granite rock, or schistose forma- 
tions. Generally speaking, the water of the higher situations is 
soft : of the lower, hard. 

The following table, from Dr. Hooper's work, 1 shows the distri- 
bution of temperature throughout the year. 

TABLE, 

Showing the mean temperature of the months, seasons, and uhoU year] 
averaged on the years 1S3 1-32-33-34 and 35. 

March, 45.75 ~) 

April, 50.09 C Spring, .... 50.97^ 

May, 57.08 J 



June. . 
July/ . 
August, 



61.31 
63.50 
63.72 



September, 

October. 

November, 

December, 

January, 

February, 



59.S2 

55. 

48. 



&2~) 

.65 C 
.423 

. . . . 45.27} 
. . . . 41.5SC 
. . . . 44.623 



Summer, 



Autumn, . 



Winter, 



62.S4 



54.63 



y 53.06 



43.S2 ! 



From its small size, and from its situation in the current of the 
channel, Jersey is freely exposed to all winds. High winds are 
very prevalent. A perfectly calm day, even in summer, is rare; 
and, generally speaking, says Dr. Scbolefield. even the finest 
weather may be called '-- blowy." 2 The western breezes, according 
to Dr. Hooper, occupy two thirds of the year. The northeast wind 
often reigns continuously for a considerable time, particularly in 



1 Observations on the Topography, Climate, and Prevalent Diseases of 
the Island of Jersey. By George S. Hooper, M. D.. London. 1S37. 

2 Inglis's Account of the Channel Islands. Appendix by Dr. Scholefield. 



CLIMATES OP ENGLAND. 97 

the spring months, and then it is severely felt by the delicate in- 
valid. 

The actual fall of rain in Jersey does not appear to have been 
measured. Dr. Hooper states, that the number of rainy days falls 
short of that of the south and southwestern coasts of England; but 
he is inclined to think, that if the quantity of rain was estimated 
by a rain gauge, it would be found greater at Jersey, as the showers 
there are generally copious and of long duration. In addition to 
the quantity of rain which falls, the thickly wooded state of the 
island, and the imperfect drainage, contribute to the extreme 
humidity of Jersey. 

" It may be said," observes Dr. Hooper, " that the island of Jersey 
enjoys an early spring and a protracted autumn ; vegetation being 
usually active and forward in March, and the landscape of the 
country far from naked so late as the end of December. The 
dreary aspect of winter, therefore, is short lived. With rare ex- 
ceptions, the latter season passes off in soft or windy weather, with 
intervals of astonishingly mild days, and with scarcely any frost or 
snow. The prevailing winds of this season are the west and south- 
west, and the actual temperature, its variations and ranges, are all 
in favour of the island, compared with other places in neighbour- 
ing latitudes. The season of spring is of course marked by the 
same unsteadiness of temperature and harsh variations of weather, 
as in most places under a similar latitude ; and this disadvantage 
is particularly felt in May, which often fails to bring with it the 
expected enjoyments. The month of March, on the contrary, is 
comparatively mild, and so is October." Dr. Hooper farther re- 
marks, (p. 71,) that the general qualities of the climate of Jersey 
may be made available to the invalid, to whose case they are appli- 
cable, during a period of six months in the year. 

St. Helier's, the capital of Jersey, Dr. Scholefield says, is not 
favourably situated for exercise, and is peculiarly subject to rain 
and fogs. The most healthy situations in Jersey, according to Mr. 
Murray, are on the southwest side of St. Heliers parish. The 
eastern side is also healthy ; and St. Aubin's, about three miles to 
the west of St. Heliers, is considered one of the best situations for 
invalids. 

The most prevalent disease in the Channel Islands is chronic 
rheumatism, which among the people of the rural districts is uni- 
versal after the age of thirty ; dyspepsia, diseases of the liver, and 
dropsy are also prevalent. Scrofula is common, particularly among 
the Jewish part of the population. Intermittent and remittent fevers 
are frequent ; and diseases of the skin very much so. Phthisis is 
said not to be frequent, but no accurate statistical account is given. 
Calculous diseases are rare ; inflammatory diseases are not of acute 
character, and the natives do not bear bleeding well. 

The climate of the Channel Islands has a close resemblance to 
that of the southwest coast of England, and especially to Penzance. 
There are the same equable temperature, the same soft humid 
1— g 7 dark 



98 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

atmosphere, and the same liability to high winds during the winter, 
and cold northeast winds in the spring, which characterise the 
latter place. So close is the affinity of their climates, and so similar 
their influence on disease, that the remarks which have been made 
on the southwest of Devonshire, and the Land's End, as residences 
for invalids, are perfectly applicable to the Channel Islands. 1 



CLIMATE OF FRANCE. 

The south of France has long been held in estimation for the 
mildness of its winter climate, and various parts of it have been 
and are still resorted to by invalids. The southern provinces, as 
regards climate, admit of being classed under two divisions, namely, 
the southeastern and the southwestern ; differing essentially from 
each other in the physical characters of their climate, and the in- 
fluence of this on disease. 

SOUTHWEST OF FRANCE. 

The climate of the southwestern provinces of France resembles 
in its general qualities that of the southwest of England ; the mean 
annual temperature being about 4° higher. The climate may be 
characterised as soft, relaxing, and rather humid. 

Laennec found the southern coast of Brittany favourable to con- 
sumptive patients ; and he also observed that the proportion of 
consumptive diseases in this part of France, was comparatively 
small. Generally speaking, the climate of the southwest of France 
will be found useful in chronic inflammatory affections of the 
mucous membranes accompanied with little secretion, as in chronic 
bronchitis not attended by much expectoration, or difficulty of 
breathing, and in similar morbid states of the larynx and trachea. 
It will be equally proper in dry scaly eruptions of the skin ; in 
dysmenorrhea ; in certain kinds of headach, especially those in- 
duced or exasperated by sharp northeast winds ; and in high 
morbid sensibility in general, when accompanied with that habit 
of body which the ancients called striatum. On the other hand, 
the same diseases occurring in relaxed habits, in which there is a 
disposition to copious secretion, will be aggravated by this climate. 

PAU. 

Pau, the capital of the Department of the Lower Pyrenees, and 
the only place in this district of which I consider it necessary to 

1 For fuller and more particular information regarding Jersey, Dr. Hooper's 
work, already referred to, may be advantageously consulted. 



CLIMATE OF FRANCE. 99 

give a particular account, is finely situated upon a ridge of gra- 
velly hills, overlooking an extensive valley to the north. The 
Pyrenees rise gradually behind it, their higher range being nearly 
forty miles distant. Pau is about 150 miles from Bourdeaux, and 
50 "from Bayonne. Having made but a short visit to this place 
myself, I am principally indebted for the following account of it to 
the kindness of Dr. Playfair, (now of Florence,) who resided there 
for several years. 

Although the character of the climate of Pau corresponds with 
that of the southwest of France generally, it possesses some pecu- 
liarities which it owes to its topographical situation. Notwith- 
standing its distance from the coast, it is very much under the 
influence of the Atlantic. All the changes to which this gives rise 
extend as far as Pau, though modified, in some degree, by distance, 
and still more, by the position of the place with respect to the 
neighbouring mountains. Calmness, for example, is a striking 
character of the climate, high winds being of rare occurrence and 
of short duration. 

The mean annual temperature of Pau is 4£° higher than that of 
London, and about 3° higher than that of Penzance ; it is about 5° 
lower than that of Marseilles, Nice, and Rome, and 10° lower than 
that of Madeira. In winter, it is 2° warmer than London, 3° colder 
than Penzance, 6° colder than Nice and Rome, and 18° colder than 
Madeira. But in the spriiig, Pau is 6° warmer than London, and 
5° warmer than Penzance : only 2?° colder than Marseilles and 
Rome, and 7° colder than Madeira. The range of temperature be- 
tween the warmest and coldest months at Pau is 32° ; this at Lon- 
don, and likewise at Rome, is 26° ; at Penzance it is only 3 8°, and 
at Madeira 14°. The daily range of temperature at Pau is 7|- ; at 
Penzance it is 6i° : at Nice, Si "; at Rome, 11°. 

The annual quantity of rain has not been measured at Pau. The 
number of days in which rain falls is 109 ; nearly the same as at 
Rome, and about seventy less than at London. The west wind 
blowing directly from the Atlantic, is accompanied with rain ; the 
wind from the northwest, and from this point to the northeast, 
brings dry, cold weather ; while that from the northeast to the 
south, is usually attended by clear, mild weather. The south, and 
southwest winds, are warm and oppressive. The westerly, or 
Atlantic winds, are the most prevalent; the north wind blows 
feebly, and is not frequent ; the oppressive southerly winds are of 
rare occurrence, and seldom continue beyond twenty-four hours. 
Indeed, Pau appears to be almost exempt from the oppressive 
southerly winds on the one hand, and the cold northwest winds on 
the other ; both of which prevail over this part of France generally. 
The easterly winds are next in frequency to the west, with which 
they usually alternate, and it is observed that, according as the one 
or other wind prevails, the weather is rainy, or dry and pleasant. 

Though from the more -frequent occurrence of westerly winds, 
this climate may be said to be rainy, still it is not subject to some 

7* 



?<& _ •> 

100 CLARK ON THg SANATIVE INFLUENCE OF CLIMATE. 

oftheevils which cfmmonly attend humid climates; or, at least, it 
suffers from the© in a less degree than these generally do. Rain 
seldom ccjnjiatles above two days at a time, and is usually followed 
hours by warm sunshine ; while the ground, from the 
absorbing nature of the soil, dries rapidly. The atmosphere, gene- 
rally speaking, is also remarkably free from moisture, as indicated 
by the hygrometer. In October, some snow generally falls on the 
centre chain of the Pyrenees ; and. at Pan, this fall is marked by a 
sudden change of temperature, the weather becoming rainy and 
chilly. In November, the weather clears up, and becomes milder. 
December and January are cold and dry ; frost and slight snow 
showers then occur, but the snow does not lie on the ground. The 
sun is bright and warm ; and from twelve till three o'clock, an 
invalid may generally take exercise. February is milder; but, 
towards the end of this month the spring rains fall, and the weather 
is then chilly and disagreeable. March is mild, but variable; 
though there are no cutting winds. In spring, westerly winds, 
which are soft and mild, accompanied with rain, alternate with dry 
easterly winds, also of a mild character. Hence it is, that the 
vernal exacerbation of inflammatory affections of the stomach and 
lungs, so commonly observed in other climates, is little felt by in- 
valids at Pan. Vegetation bursts forth in the first week of April, 
which is a warm month. May resembles April, but is warmer. In 
June the weather is hot and fine. July. August, and September, 
are very hot months, the thermometer sometimes rising as high as 
94° in the shade ; with a very powerful sun, preventing exercise 
from eight in the morning till seven in the evening. 

According to Dr. Playfair, the good qualities of the winter cli- 
mate of Pau may be summed up as follows : — Calmness, moderate 
cold, bright sunshine of considerable power, a dry state of atmo- 
sphere and of the soil, and rains of short duration. Against these 
must be placed — changeableness, the fine weather being as short 
lived as the bad ; rapid variations of temperature, within moderate 
limits. In autumn and spring there are heavy rains. 

Pau is upon the whole healthy. Intermittent and bilious fevers, 
and rheumatism, are the most prevalent diseases. Rheumatism, 
according to a native author, is the only disease that is very com- 
mon ; it exists almost as an endemic, and simulates or complicates 
almost all the other diseases. 1 Goitre is also very common among 
the peasantry. The intermittent fevers occur chiefly among the 
peasants who frequent the low damp grounds in the neighbourhood. 

There are several circumstances in the climate of Pau which 
render it a favourable residence for a certain class of invalids. The 
atmosphere, when it does not rain, is dry, and the weather fine, 
and there are neither fogs nor cold piercing winds. The charac- 
teristic quality of the climate, however, is the comparative mild- 
ness of its spring, and exemption from cold winds. While the 

1 Journal de Physiologie, torn. vii. p. 303. 



CLIMATE OF FRANCE. 101 

icinter is 3° colder than the warmest parts of England, and 6° 
colder than Rome, the spring is 5i° warmer than the former, and 
only 2f° colder than the latter. The mildness of the spring, and 
its little liability to winds, render this place favourable in chronic 
affections of the larynx, trachea, and bronchi. In gastritic dys- 
pepsia Dr. Playfair has found it beneficial, and he has seen it useful 
in a few cases of asthma. With delicate children, also, he found 
the climate agree well, especially when they removed to the moun- 
tains during the summer. 

Upon the whole, Pau appears to be the most desirable winter 
residence in the southwest of France, for invalids labouring under 
chronic affections of the mucous membranes. In the same class of 
diseases, the mineral waters of the Pyrenees are also very benefi- 
cial ; and it may be convenient, and advisable, for the invalid, who 
has derived benefit from a course of these waters, to pass the winter 
at Pau, with a view of returning to them in the following season. 

Invalids labouring under, or subject to attacks of rheumatism, 
should, of course, avoid Pau. In bronchial diseases, also, when 
accompanied with much general relaxation of the system, and with 
copious expectoration and dyspnoea, the climate will not in general 
prove beneficial ; and Dr. Playfair considers it too changeable in 
consumptive diseases. 

Dr. Foville, who passed two years at Pau, for the benefit of his 
own health, considers the above account of its climate correct in 
the main, but in some respects too favourable. Its greatest advan- 
tage is the constant calmness of the air. He thinks the climate 
uncongenial to persons with delicate chests. The inhabitants, he 
says, are generally healthy, and the mortality less than in most 
cities of France. 

Invalids, who mean to pass the winter at Pau, should arrive there 
in the end of September, or very early in October. 

In fixing the period for leaving Pau, the destination of the person 
must be taken into account. If the object is to return to England, 
he may leave it in May ; if he means to spend the summer among 
the Pyrenees, he should not leave it before June. The best season 
for using the mineral waters of the Pyrenees commences about 
the first "of July. 

SOUTHEAST OF FRANCE. 

Various places in the southeast of France have been, at different 
times recommended as affording a good winter climate for con- 
sumptive patients ; but nothing can be more unaccountable than 
how such an advice ever came to be given ; as the experience of 
later years is in complete opposition to it. and the general and lead- 
ing characters of the climate show, that there never was the least 
reason to sanction it. Haw the practice of sending consumptive 
invalids to the southeast of France originated, it is not of importance 
to inquire ; but that it is founded on error, I think I shall be able 



102 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

to prove, by a reference to the total want of success which has 
attended it, as well as to the physical characters of the climate. 

The mean annual temperature of Provence generally, is 58° : 
that is, about 7° warmer than the southwest of England, 3° warmer 
than the southwest of France, and about a degree below Italy, in- 
cluding the climate of the lower Apennines. Its winter temperature 
is 43°; being only 1£° above the southwest of England, and 1° 
above the southwest of France, while it is 3° under Italy. The 
spring temperature is 55°; namely, 6° above the southwest of Eng- 
land, 1° above the southwest of France, and 2° below Italy. The 
temperature is distributed very unequally through the year ; the 
difference of the mean of the warmest and the coldest months being 
35° ; this in the southwest of England is 22°, in the southwest of 
France 30°, in Italy 32°, and in Madeira only 14°. 

Dryness is one of the most remarkable characters of the climate 
of Provence. At Marseilles and Toulon, about nineteen inches of 
rain fall annually. This is less by six inches than what falls at 
London, and is not half so much as falls in the southwestern ex- 
tremity of Cornwall. The annual number of days on which rain 
falls in Provence, is only sixty-seven, while at London it is 178. 
Again, in Provence (at Toulon) the quantity of water evaporated 
annually, is forty inches, while at Paris it is thirty-two inches, at 
Gosport twenty-five, and at London only twenty-four. When these 
circumstances are taken into consideration, together with the high 
mean temperature, the climate of Provence appears the driest in 
Europe. Indeed, the dry nature of the soil, and the bare parched 
aspect of the country, bespeak this. 

The general character of the climate of the southeast of France 
is thus dry, hot, and irritating. Its temperature throughout the 
year and the day is distributed with great irregularity, and the 
range is much wider than in our own climate; being, as three to 
one for the year, and as two to one for the day. The temperature, 
no doubt, remains more steady from day to day, than our own; but 
its changes, though less frequent, are more sudden and extensive. 
Sometimes the winter is very rigorous. The orange trees are 
occasionally killed by the cold in the most sheltered parts of Pro- 
vence. In 1709 the ports of Marseilles and Toulon were frozen 
over. 

This tract of country is subject also to keen, cold, northerly 
winds, especially the mistral, which prevails during the winter and 
spring, and is most injurious in pulmonary diseases. 

Although decidedly improper for consumptive patients, and for 
those labouring under irritation of the mucous membranes of the 
stomach, larynx, or trachea, this climate may prove useful to invalids 
of a different class. On persons of a torpid, or relaxed habit of 
body, and of a gloomy, desponding cast of mind, with whom a 
moist relaxing atmosphere disagrees, the keen, bracing, dry air of 
Provence, and its brilliant skies, wiil often produce a beneficial 






CLIMATE OF FRANCE. 103 

effect. In some cases of chronic intermittent fevers, also, it proves 
very favourable. 

The distinctive characters of the climate prevail more or less in 
the different places resorted to by invalids, but none can be con- 
sidered as exempt from them. The remarkr which I have to make 
on these places individually, are derived partly from native practi- 
tioners, and partly from my own observation ; and it will be found, 
I think, that the particular facts confirm the general character given 
of the whole southeast of France, from Montpelier to Nice. 

MONTPELIER. 

The celebrity of the medical school at Montpelier, had probably 
a considerable share in giving rise to the character which this place 
obtained for the benignity of its climate — olim Cous nunc Monspe- 
liensls. But whatever may have been the merits of its medical 
school, it will be easy to show, that the climate little deserved the 
reputation which it long enjoyed as a residence for the consump- 
tive. I prefer the evidence afforded on this subject by native authors. 
31. Murat, in his Medical Topography of Montpelier, published in 
1810, states on the authority of M. Fournier. y the following propor- 
tion of deaths from consumption, at the Hotel Dieu, of that city, in 
the year 1763. The total number of patients that passed through 
this hospital in the course of the year was 2,756. The total num- 
ber of deaths was 154; and of this number fifty-five died of pulmo- 
nary consumption ; that is, more than a third of the whole. After 
alluding to M. Fouquier's opinion, that phthisis was still more 
frequent at a former period, he adds, "Mais la phthisie pulmonaire 
n'est que trop repandue dans ce pays : elle y enleve meme des 
families entieres ; et la position de la ville, et la constitution seche 
et variable des saisons physiques, sont des causes locales qui la 
developeront toujours." 1 M. Fournier, the author from whom the 
above numbers are taken, observes, when noticing the prevalence 
of northerly winds at Montpelier, during the winter and spring, "II 
faunt avoir la poitrine bien bonne et bien constitute pour resister a 
ses impressions/' 2 Other circumstances in the topography and 
nature of the climate of Montpelier might be stated to show its 
unfitness as a residence for consumptive patients, but surely it is 
unnecessary to adduce further evidence on the subject. Consump- 
tive patients are frequently sent from this place to the village of 
Gauche, at the foot of Cevennes, about two leagues distant. 

MARSEILLES. 

This place is but little intitled to claim any exemption from the 
general character of the climate of Provence. It is open to the full 

1 Topographie Medicale de'la Ville de Montpelier, p. 149. 
'Recueil d'Observations de Medecine des H6pitaux Militaires, par M. 
Richard de Hautsierck, tern. ii. p. 5. 



104 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

influence of the cold winds of this country, and especially to the 
mistral. There is, moreover, no part of the neighbourhood of Mar- 
seilles, wheru invalids can take exercise, when the weather does 
permit them to go out ; one of the principal objects for which they 
left their own climate. The country around the city is divided 
into small properties, each enclosed by high walls, between which 
the roads in every direction lead for miles. The dry, arid nature 
of the soil, renders these roads in general very dusty, and the nar- 
row winding form, subjects them to gusts of wind ; both of which 
circumstances makes them most improper exercising ground for 
invalids labouring under pulmonary irritation. Indeed, it may be 
almost said, that there is no country about Marseilles, at least for 
the stranger residing there. But the character of the climate is still 
more objectionable. It is dry, variable, and subject to cold irritating 
winds, which are particularly injurious to consumptive patients. 
Marseilles is indeed, one of the towns in France in which pulmo- 
nary consumption is most prevalent. A large proportion of the 
youth of both sexes is carried off by it. Females, from fourteen to 
eighteen years of age, are said to be its most frequent victims. To 
use the words of a native author: "II fait des ravages inouies en 
moissonnant la plus belle jeunesse." 1 Scrofula attacking the ex- 
ternal parts of the body is rather a rare occurrence at Marseilles. 
Pleurisy and catarrh are frequent ; as are cancer and cutaneous 
eruptions. Diseases of the uterine system are also common. 

Invalids requiring a dry climate, and capable of bearing keen, 
cold winds, will be benefited by a residence at Marseilles : patients 
labouring under intermittent fevers often get rid of them on coming 
to this place. 

HYERES. 

The little town of Hyeres, agreeably situated on the southern de- 
clivity of a hill, about two miles from the shores of the Mediter- 
ranean, and twelve from Toulon, is the least, exceptionable residence 
in Provence for the pulmonary invalid. It is in some degree pro- 
tected from the northerly winds, and has the advantage of being 
situated in a beautiful, open country. Immediately under the town, 
the orange tree is cultivated in abundance. It is the hardiest species, 
and thrives very well in general, being little injured by the winter. 
It has, nevertheless, happened several times, although after an in- 
terval of many years, that the cold has been sufficiently intense to 
destroy the whole of the orange trees at Hyeres in one night. This 
occurred last in the winter of 1820, on which occasion not a single 
orange tree escaped ; and many of the olive trees, in the most ex- 
posed situations, were also partially killed. 

The lower grounds are occupied with vines and corn, and about 

1 Expose des Travaux de la Societe de Medecine de Marseilles, 1816, par 
M. Sigaud, p. 14. 



CLIMATE OF FRANCE. 105 

the bases of the hills the olive is extensively cultivated, and attains 
a considerable size. The hills immediately surrounding Hyeres 
are finely covered with evergreen shrubs, affording a striking con- 
trast to the bare, unseemly aspect, which the hills of Provence 
generally present. The thyme, rosemary, lavender, and many 
other aromatic plants grow here in abundance; and several of 
these we find blooming in December. With all these indications 
of mildness, Hyeres is by no means sufficiently protected from the 
mistral to render it a desirable residence for consumptive invalids, 
(setting aside objections from the nature of the climate,) although it 
has been strongly recommended as such. It is true that about the 
base of the hills there are some spots sheltered from the mistral, 
where the invalid might enjoy several hours in the open air almost 
every day : but these are almost unattainable when they would be 
most useful. The chilly blast sweeping round every exposed 
corner, forbids the valetudinarian venturing there, except in a close 
carriage, while the roads leading to these places do not admit 
wheeled vehicles. When the weather does permit, the invalid 
residing at Hyeres may enjoy the advantage of a variety of rides 
through a fine open country. But when the mistral blows with 
any degree of force, he should confine himself to the house, if his 
chest be delicate ; and he must even be cautious at all times of ex- 
posing himself to this wind, which, independently of its low tem- 
perature, is very irritating. With all these objections, the climate 
of Hyeres is the mildest in Provence ; and the invalid may feel 
assured, that whatever inconveniences he is subjected to from the 
cold winds at this place, he would have experienced in a greater 
degree at any other part of the southeastern district. 

NICE. 

The climate of Nice approximates more nearly in its general 
characters to that of Provence, which has just been described, than 
to any other. Its mean annual temperature is 59°, being 9° warmer 
than London, 7° warmer than Penzance, 1° colder than Rome, and 
5° colder than Madeira. The mean temperature of winter is 48° ; 
that is, nearly 9° warmer than London, 4° warmer than Penzance, 
1° colder than Rome, and 12° colder than Madeira. The mean 
temperature of spring is 56°; being 7° warmer than London, 6° 
warmer than Penzance, 1° colder than Rome, and 6° colder than 
Madeira. The temperature throughout the year is more equally 
distributed at Nice" than at any place in the South of Europe, of 
which we have accounts, except Rome and Cadiz ; the difference 
of the warmest and coldest months being only 28°, and the mean 
difference of successive months only 4°.74. 

The range of temperature for the day is also less at Nice than at 
any other part of the south of Europe ; and in steadiness of tem- 
perature it ranks next to Madeira. 

The mild and equable character of the climate of Nice depends 



106 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

in a great measure on the position of the place with respect to the 
neighbouring mountains and the sea. The maritime Alps form a 
lofty barrier, which shelters it from the northerly winds during 
winter; and the cool sea breeze, which prevails every day, with a 
regularity almost equal to that of a tropical climate, moderates the 
summer heat. " Cet alize Mediterranean," says M. Risso, "toujours 
doux, frais et tranquille, s'eleve periodiquement vers neuf a dix 
heures du matin, cesse sou vent vers les quatre heures apres midi, 
et s'etend dans l'interieur de nos Alpes rarement au dela de huit 
myriametres." ' These circumstances explain the small annual 
range of temperature at this place, already noticed, and which a 
reference to the table in the Appendix will show to be much less 
than at most parts of Italy. 

Notwithstanding the extent, however, to which Nice and its envi- 
rons are encircled by mountains, (and it is so in a great measure 
from W. S. W. to E. S. E.,) it is by no means exempt from 
cold winds during the winter, and still less so during the spring. 
The easterly winds are the most prevalent during the latter 
season. They range from east to northeast, frequently blow with 
considerable force, and are often accompanied with a hazy, cloudy, 
state of atmosphere. Sometimes this wind sets in towards the 
forenoon, at other times not until the afternoon. When the early 
part of the day is fine, it never should be lost for exercise ; as 
the afternoon frequently proves cold and windy, after a calm mild 
morning. 

From the northwest or mistral, which is the scourge of Provence, 
Nice is pretty well sheltered. The force of this wind seems to be 
broken, and directed to the southward by the Estrelles, a chain of 
mountains between Frejus and Cannes. Although the mistral is 
never experienced in its full power at Nice, or only at least towards 
its termination, when it takes a more westerly direction, {la queue 
de la Mistral, as it is called,) the keen, dry quality of the air is 
very sensibly felt whilst it prevails. It sets in generally about two 
or three o'clock in the afternoon, and is not of \ox\<y duration. The 
wind seldom blows strong directly from the north, though the air 
is very sharp when it is in that quarter. The northerly gales ap- 
pear to pass obliquely over Nice. 2 The sirocco is of rare occurrence, 

1 Histoire Naturelle de Principales Productions de I'Europe Meridionale, 
et particulierement de celles des Environs de Nice. 1825, par A. Risso. Vol. 
i. p. 219. To this excellent work I beg leave to refer ray readers who may 
be desirous of information respecting the Natural History of the south of 
Europe. 

1 " On eprouve fort rarement," says M. Risso, "toute sa force dans les 
couches inferieures de Pair qui environnent le plateau de Nice, a cause du 
triple rang de montagnes qui l'entourent; il occupe presque toujours les 
couches superieurs, et descend en pente comme un grand torrent aerien sur 
la mer ; car on apercoit a un kilometre du rivage qu'il commence a en friser 
la surface pour former un peu plus loin des vagues qui, s'elevant les unes 
sur les autres. vont porter les tempetes sur les cotes boreales d'Afrique." — 
Hist. Nat. vol. i. p. 216. 



CLIMATE OF FRANCE. 107 

and when it does pay a visit, it is gentle, and not unpleasant to the 
feelings of invalids in general. 

The weather at Nice during the winter is comparatively settled 
and fine, the atmosphere being generally clear, and the sky remark- 
able for its brilliancy. The temperature seldom sinks to the freez- 
ing point, and when it does, it is only during the night ; so that 
vegetation is never altogether suspended. Indeed, at Nice, winter is 
a season of flowers, the dryness of the air rendering the same degree 
of cold less injurious to them, than it would be in a more humid 
atmosphere. Spring is the most unfavourable season ; the sharp, 
chilling, easterly winds are the greatest enemy with which the inva- 
lid has to contend ; and the prevalence of these during the months 
of March and April is admitted, I believe, by all who have felt them, 
to form the greatest objection to this climate, especially in pulmo- 
nary diseases. 

The climate of Nice is altogether a very dry one. Rain falls 
chiefly during particular seasons. From the middle of October to 
the middle of November it generally rains a good deal ; also about 
the winter solstice there is commonly some rain, and again, after 
the vernal equinox. The quantity of rain that falls during the year 
has not been accurately estimated. 

Upon the whole, in the physical qualities of its climate, Nice 
possesses some advantages over the neighbouring countries of 
Provence and Italy, inasmuch as it may be said to be free from the 
sirocco of the latter, and protected from the mistral of the former. 

Nice is upon the whole a healthy place. Catarrhal affections 
and inflammation of the lungs rank among the most frequent 
diseases. The latter is especially common and violent in the 
spring, and is generally complicated with irritation of the digestive 
organs. Pulmonary consumption is much less frequent in England 
and France. Gastric fever and chronic gastritis are very common 
diseases. Indeed, gastric irritation appears to be very prevalent ; 
and almost all other diseases are complicated with more or less of it. 
Intermittent fevers are not unfrequent among the peasantry living 
or labouring in unhealthy situations in the country. The flat 
ground on the banks of the Var is the most fruitful source of these 
fevers. The guards stationed on the bridge which crosses this 
boundary stream, are frequently attacked with ague, during the 
unhealthy season, though they remain there only a few days at a 
time. This is a disease, however, from which the winter resident 
at Nice has nothing to fear. Dr. Skirving, during a long residence 
there, met with one case only of ague amongst the strangers. 
Diseases of the eyes are very prevalent, particularly amaurosis and 
cataract ; cutaneous diseases are also very common. The elephan- 
tiasis of the Greeks is occasionally observed in certain warm spots 
in the neighbourhood. It is also found sometimes in the vicinity 
of Marseilles, and, I believe, along the whole of this coast. It is 
less common in Italy, except perhaps at Naples. 

In proceeding to describe the effects of the climate of Nice on 



108 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

disease, I feel it due to Dr. Skirving, who practised there many- 
years, to state, that I am much indebted to him for favouring me 
with the results of his extensive experience. 

In consumption, the disease with which the climate of Nice has 
been chiefly associated in the minds of medical men in this country, 
little benefit I fear is to be expected from it. When this disease 
is complicated with an irritable state of the mucous membranes 
of the larynx, trachea, or bronchi, or of the stomach, the climate 
is decidedly unfavourable ; and, without extreme care on the part 
of the patient, and a very strict regimen, the complaint will in 
all probability be aggravated by a residence at Nice. Indeed, the 
cases of consumption which ought to be sent to this place are of 
rare occurrence. If there are any such, it is when the disease exists 
in torpid habits, of little susceptibility, and is free from the compli- 
cations which have been just mentioned. Even the propriety of 
selecting Nice as a residence for persons merely threatened with 
consumption, will depend much upon the constitution of the indi- 
vidual. Dr. Skirving has met with cases which leave no doubt on 
his mind, that a residence for one or two winters often proves of 
advantage, as a preventive measure, in young persons predisposed 
to this disease ; and even in some instances when there was every 
reason to believe that tubercles already existed in the Jungs, the 
climate has appeared to be useful. But in the advanced stage of 
consumption, his opinion, founded on eight years' experience, ac- 
cords with what has been already stated ; and this is still further 
supported by the testimony of Professor Fodere, of Strasbourg, 
who resided six years at Nice. 1 Indeed, sending patients, labour- 
ing under confirmed consumption, to Nice, will, in a great majority 
of cases, prove more injurious than beneficial. 

In chronic bronchitis, which often simulates phthisis, very salu- 
tary effects are produced by a residence at this place. Such pa- 
tients generally pass the winter with comparatively little suffering 
from their complaint, and with benefit to their general health. 
They are here able to be much in the open air, whereas, if they 
had remained in England, they would in all probability have been 
confined during the greater part of the winter to the house. The 
particular kind of bronchial disease most benefited by a residence 
at Nice, is that which is accompanied with copious expectoration, 
whether complicated with asthma, or otherwise; and in the chronic 
catarrh of aged people it is particularly beneficial. This variety of 
bronchial disease is directly the reverse of that which is mitigated 
by the southwest of France and of England : and I think it im- 
portant here to remark, that unless the distinctions which I have 
pointed out in bronchial diseases, and their complications, are 
attended to, great errors must be committed in selecting a residence 

1 See Voyage aux Alpes Maritimes, ou Histoire Naturelle, Agraire, 
Civile et Medicale du pays de Nice, &c. Strasbourg, 1823. 



CLIMATE OF FRANCE. 109 

for such patients. For fuller information on this subject, the reader 
is referred to the article on "bronchial diseases." 

The gouty invalid may, in most cases, escape his usual winter 
attack; and, provided he lives with prudence, his general health 
may be improved by a winter's residence at Nice. 

In chronic rheumatism, the climate is generally very beneficial ; 
and its advantages are also remarkable in scrofulous complaints. 
On children the climate generally exerts a very favourable influ- 
ence, if attention be paid to their diet. 

In the numerous train of hypochondriacal and nervous symp- 
toms which often originate in dyspeptic complaints, Nice is bene- 
ficial ; but here, again, it is necessary to distinguish the particular 
character of the affection. The cases of dyspepsia most benefited 
are those accompanied with a torpid, relaxed state of the system, 
with little epigastric tenderness, or any of those symptoms which 
denote an inflamed or very irritable state of the mucous membrane 
of the stomach. Where the latter state prevails, Nice will de- 
cidedly disagree. But I must refer to the article on " disorders of 
the digestive organs" for more precise directions regarding the best 
winter residence for persons suffering from stomach complaints. 

In all cases where there is great relaxation and torpor of the 
constitution, the climate of Nice is extremely useful. In young 
females labouring under such a state of system, connected with 
irregularities of the uterine functions, either when these have not 
been established at the usual period, or when they have afterwards 
been suppressed, marked benefit may generally be expected. In 
indicating the class of cases alluded to, as likely to derive advantage 
from the climate of Nice, I would designate them to the practical 
physician as those that are usually relieved by chalybeates. 

In a numerous class of patients, whose constitutions have been 
injured by a long residence in tropical countries, by mercury, &c, 
and in which a dry and rather exciting climate is indicated, Nice 
will prove favourable. Some cases of chronic paralysis, not con- 
nected with cerebral disease, have also been found to derive con- 
siderable benefit from a residence at this place. 

In stating its general influence on the animal economy, I would 
say — that the climate of Nice is warm, exhilarating, and exciting, 
but upon the whole, irritating — more especially during the spring 
— at least to highly sensitive constitutions. It is extremely favour- 
able to the productions of the vegetable kingdom, some of which 
flourish here in a degree of luxuriance that is scarcely to be equaled 
in the other parts of the south of Europe. 1 

1 " Peude contrees meridionales de l'Europe offrent un tableau aussi varie 
en vegetaux indigenes et exotiques que les environs de Nice. Dans le fond, 
c'est une masse d'oliviers qui s'etend sur toutes les collines, et dispairait 
insensiblement a mesure qu'elle s'eloigoe du rivage de la mer. Sur le 
devant, ce sont des orangers, des bigaradiers, des limoniers, disposes en 
jardins qui offrent toute la luxe des Hesperides. Pour relever la sombre 
verdure des uns et la monotonie des autres, des caroubiers, des figuiers, des 



110 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

Invalids who pass the winter at Nice, scarcely ever reside in the 
town. Some good lodgings, and tolerably well situated, overlook- 
ing the terrace, are, however, now to be had ; but in the suburb, 
palled the Croix de Marbre, and along the sea beach, from the 
town to the ridge of mountains where the plain terminates on the 
west, the largest and best houses are to be found ; and here stran- 
gers generally reside. At the foot of the hill on which stood 
Cimiez there are also some good houses ; and this is a situation 
preferable to the lower part of the plain for patients very suscep- 
tible of injury from damp. 

Invalids should endeavour to arrive at Nice about the middle of 
October, or sooner, and should not leave it before the beginning of 
May. Whatever may be the inconvenience here experienced from 
the spring winds, the same will be felt in a much greater degree by 
returning through the South of France ; and, accordingly, both 
Dr. Skirving and myself have known invalids suffer materially 
from the winds of Provence by leaving Nice too early. It is true 
that the new road which has lately been opened between Nice and 
Genoa, admits of the invalid moving in that direction, at a much 
earlier period than it would be advisable for him to return over the 
Estrelles to Provence; and when the climate of Nice is found to 
disagree, a change in the spring in the direction of Genoa may, in 
some cases, be advisable. 

Villa Franca. — This little town, situated on the southern base 
or rather declivity of a steep and lofty range of mountains, and 
having a beautiful bay extended out before it, is immediately to the 
eastward of Montalbano, which separates the bay of Villa Franca 
from that of Nice. From the north and northwest winds this place 
is certainly more effectually protected than Nice ; it is also shel- 
tered from the northeast, but open to all other easterly winds. In 
its general characters the climate corresponds closely with that of 
Nice ; it is said to be still drier and somewhat warmer, and it is 
certain that the vegetable productions are considerably earlier than 
at Nice. At present there are very few accommodations at "Villa 
Franca, and the communication with Nice is extremely inconve- 
nient. It has long been in contemplation to cut a good road along 
the sea shore between these two places. Should this be accom- 
plished, the accommodations at Villa Franca will, no doubt, be 
speedily increased ; as sites for building may be found in this 
secluded little vale more effectually protected from cold winds than 
any part of the more open and extended plain of Nice. 

Menton is also a very sheltered spot, about fourteen miles from 
Nice on the Genoa road ; and San Be/no, still further, is even 
more protected from easterly winds. The great mildness of both 



jujubiers, des raquettiers, des dattiers, des grenadiers, et toutes sortes 
d'arbres fruitiers distribues sans ordre, en elalant toute leur vigueur. ache- 
vent d'orner et d'embeliir ce bel ensemble." — Histoire Naturelle, dec. vol. i. 
p. 313, &c. 



CLIMATES OF ITALY. Ill 

places is indicated by the flourishing state of their lemon planta- 
tions. And at Bordighera, in the neighbourhood of the latter, the 
palm-tree is cultivated on a large scale for the sake of its etiolated 
leaves, of which it has long afforded a supply for the ceremonials 
of the church of Rome. But the want of accommodation at these 
places, at present, prevents the invalid, to whom a change from 
Nice might be advantageous, from availing himself of it. The in- 
creased number of travellers, however, who now pass by the road, 
lately formed from Nice to Genoa, will most probably soon afford 
the means of improving the accommodation along this beautiful 
coast. 



ITALY. 



Italy possesses great diversity of climate, but my observations are 
limited to the part situated between the base of the Apennines, and 
the shores of the Mediterranean. The climate which prevails over 
the whole of this region, while it exhibits a great similarity of cha- 
racter, differs in several respects from any of the climates already 
noticed. It is considerably warmer and less humid, but subject to 
a greater range of temperature than that of the southwest of France ; 
it is softer, less dry, and less harsh and irritating than that of Pro- 
vence ; suffering more from the heavy oppressive winds of the 
south, and less from the dry searching winds of the north. 

The principal circumstance which appears to modify the general 
character of this climate at the different places, is, their relative 
position with respect to the sea-shore and the Apennines. In this 
there is considerable variety; Genoa and Naples are in the vicinity 
of both, as the mountains at these places approach closely to the 
Mediterranean ; Pisa is only a few miles distant from the latter, 
and close to the Tuscan hills, a branch of the lower Apennines ; 
Rome is about twelve miles from the coast, and nearly twice that 
distance from the mountains ; Florence is quite embosomed in the 
Apennines, and the character of its climate is thereby affected to 
such a degree as scarcely to admit of its being classed with the 
other Italian climates. 

GENOA. 

The situation of Genoa, hemmed in between a range of steep 
mountains and the sea, with little or no surrounding country well 
adapted for exercise, renders it an unsuitable residence for invalids 
generally ; nor is there much in the character of the climate to 
recommend it. The summer is hotter, and the winter colder than 
at Nice ; the difference between the mean temperature of the 



112 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

warmest and coldest months being 35°, while at Nice it is only 28°. 
The distribution of heat throughout the year is also very unequal, 
and the temperature by no means steady from day to day. The 
air is sharp and exciting, but with less of the irritating quality than 
that of the southeast of France. The climate is, on the whole, dry 
and healthy, but not suitable to delicate, sensitive invalids. It is 
more congenial to relaxed, phlegmatic habits. Dyspeptic com- 
plaints and gout are said to prevail less at Genoa than at most 
parts of Italy. For pulmonary affections, Genoa is decidedly an 
improper residence. It is subject to frequent and rapid changes of 
temperature, and to dry cold winds from the north, alternating 
with warm, humid winds from the southeast — the two prevailing 
winds of the place. To these rapid changes are attributed the in- 
flammatory affections of the respiratory organs, which, with tuber- 
cular consumption, cause the greater part of the mortality of Genoa. 
In some places in the neighbourhood, more sheltered from these 
winds, inflammatory affections of the lungs are much less common 
than in the city and its immediate vicinity. Consumption is said 
to be less rapid in its course at Genoa than in Provence. Rheu- 
matism is frequent, while gout, as already mentioned, is compara- 
tively rare, as are calculous diseases. Scrofula is common. Inter- 
mittent fevers are rare, and of mild character. 

FLORENCE. 

Though Florence is one of the most agreeable residences in 
Italy, it is far from being a favourable climate for an invalid, and 
least of all, for an invalid disposed to consumption. 

Its situation among the lower Apennines, by which it is almost 
encircled, and the summits of which are covered with snow during 
the winter, together with its full exposure to the current of the 
valley of the Arno, renders Florence subject to sudden transitions 
of temperature, and to cold piercing winds during the winter and 
spring. Fogs, too, are more common here than at most parts of 
Southern Italy. The winter temperature is upon the whole low, 
while that of the summer is high. The mean annual temperature 
is only li° below that of Rome; but this is owing to the great heat 
of summer at Florence ; for the winter is only 4° warmer than that 
of London, and is nearly of the same temperature as the winter at 
Penzance. The difference between the mean temperature of the 
warmest and coldest months is 36°, which is one degree more than 
that of Provence. Nevertheless, although the daily, monthly, and 
annual ranges of temperature are very great, the climate is not 
more variable or unsteady from day to day than that of Rome, and 
is less so than that of Naples. The annual range of atmospheric 
pressure is greater than that of the neighbouring places. The an- 
nual fall of rain at Florence is 31.6 inches, but the number of days 
on which rain falls is only 103, being fewer than at Rome. In the 
winter the air is rather chilly, and loaded with moisture. 



CLIMATES OF ITALY. 113 

I do not know any class of invalids for whom Florence offers a 
favourable residence. My own opinion, founded partly on observa- 
tion, and partly on the reports of invalids, perfectly accords with 
that of Dr. Seymour of London, and Dr. Down of Southampton, 
whose more extensive opportunities of observation during a long 
residence and extensive practice at Florence, make their testimony 
of greater value. " The winter," says Dr. Down, " is extremely 
severe and wet, and the spring changeable, consequently highly 
injurious in complaints of the chest. The inhabitants are very sub- 
ject to diseases of the lungs ; and the acute inflammation of this 
organ carries off yearly in the winter and spring an amazing num- 
ber of them, particularly of the poorer classes, whose houses are ill 
calculated to afford protection against the cold and rains of these 
seasons." 1 Florence is one of the places in Italy which agrees least 
with children. Intestinal worms are particularly common there, 
and dysentery is prevalent in autumn. 

PISA. 

Pisa has long had the reputation of being one of the most favour- 
able climates in Italy for consumptive patients. It has accordingly 
been frequented, and continues to be so, by invalids from this coun- 
try. It is even resorted to, during the winter, by invalids from the 
rest of Tuscany, from the neighbouring states of Lucca, and occa- 
sionally, also, from Lombardy. 

The town is built on the banks of the Arno, about five miles 
from the sea-shore. The surrounding country is flat, except towards 
the north, where a range of hills shelters Pisa in some measure from 
the winds of that quarter. It is also protected, in a considerable 
degree, from easterly winds by the lower Tuscan hills. The Arno, 
in flowing through Pisa, makes a semi-circular sweep to the north, 
so that the buildings on the northern bank of the river (Lung* 
Arno) assume the form of a crescent facing the south, and shelter 
the greater part of the broad space between them and the river from 
northerly winds. This is the best residence for delicate invalids. 

Pisa is not so warm as Rome in winter, and is hotter in summer. 
In winter it is 7° warmer than London, and 2° warmer than Pen- 
zance. In spring it is 8° warmer than London, and about 7° 
warmer than Penzance. The range of temperature between day 
and night is very considerable. According to Professor Piazzini, 
the fall of rain annually is very great, being 45.66 inches, which is 
nearly as much as falls in Cornwall. The climate of Pisa is genial, 
but rather oppressive and damp. It is softer than that of Nice, but 
not so warm ; less soft, but less oppressive than that of Rome. For 
invalids who are almost confined to the house, or whose power of 
taking exercise is much limited, Pisa offers advantages over either 

1 Observations on the Nature and Treatment of Fevers and Bowel Com- 
plaints, &c. in Greece. By J. Somers Down, M. D. 

2— a 8 dark 



114 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

Rome or Nice. The Lung' Arno affords a warm site for their resi- 
dence, as well as a sheltered terrace for their walks ; but they must 
be careful to confine themselves to it. 

The most common acute diseases at Pisa are peripneumony, 
dysentery, and gastric fevers. Ophthalmia and cataract are fre- 
quent; but this is the case over the whole southern parts of Italy. 
Consumption is not a common disease, but chronic bronchial affec- 
tions are frequent ; and croup is occasionally met with. At one 
period, intermittent fevers were very prevalent ; but since the coun- 
try around Pisa has been drained and cultivated, they are compara- 
tively rare. In the hospital, however, a large proportion of the 
patients who undergo operations, have an attack of this fever, 
which sometimes even assumes the pernicious form. Hospital gan- 
grene is more common in the hospital at Pisa than in most other 
hospitals in Italy ; and the same may be said of diseases of the 
bones. Nervous affections likewise prevail, but not so much as at 
Rome. Calculous diseases are so rare, that Vacca, the celebrated 
surgeon, during thirty-two years that he had been operating on such 
patients from all parts of Italy, had not had occasion to operate on 
one Pisan. 

ROME. 

The climate of Rome is mild and soft, but rather relaxing and 
oppressive. Its mean annual temperature is 10° higher than that 
of London, 8° higher than Penzance, 6° higher than Pau, about 1° 
higher than Marseilles, Toulon, and Nice ; 1° below that of Naples, 
and 4° below that of Madeira. The mean temperature of ivinter 
still remains 10° higher than that of London, but it is only 5° higher 
than Penzance ; it is 7° higher than Pau, 1° higher than Nice, and 
somewhat higher than Naples ; it is 4° colder than Cadiz, and 11° 
colder than Madeira. In spring, the mean temperature of Rome is 
9° above London, 8° above Penzance, not quite 3° above Pau, and 
1° above Nice and Provence ; it is 1° colder than Naples, and only 
a little more than 4° colder than Madeira. 

In range of temperature (the extent of which is the leading fault 
of the climate of the South of Europe) Rome has the advantage of 
Naples, Pisa, and Provence, but not of Nice. Its diurnal range is 
nearly double that of London, Gosport, Penzance, and Madeira. 
In steadiness of temperature from day to day, in which our own 
country, with the exception ot the southwest of Cornwall, is so 
remarkably deficient. Rome comes after Madeira, Nice, Pisa, and 
Penzance, but precedes Naples and Pau. 

Rome, although a soft, cannot be considered a damp climate. 
Upon comparing it with the dry, parching climate of Provence, 
and with that of Nice, we find that about one third more rain falls, 
and on a greater number of days. It is, however, considerably 
drier than Pisa, and very much drier than the Southwest of France. 

At Penzance there falls about one third more rain than at Rome, 






CLIMATES OF ITALY. 115 

and the number of rainy days is also about one third greater. This 
circumstance, together with the greater evaporation at Rome, owing 
to its higher temperature, must make a considerable difference in 
the hygrometrical state of the atmosphere, at the two places. Rome 
is not so dry as Madeira ; as there falls one sixth more rain, and 
the proportion of wet days is as 117 to 73. 

From these comparisons, it would appear that the climate of 
Rome, in regard to its physical qualities, in one of the best in Italy. 
One peculiarity of it, deserving notice, is the stillness of its atmo- 
sphere ; high winds being comparatively of rare occurrence. This 
quality of calmness is valuable in a winter climate for pulmonary 
diseases, and to invalids generally, as it admits of their taking exer- 
cise in the open air at a much lower temperature than they could 
otherwise do. To patients labouring under bronchial irritation, 
wind is peculiarly hurtful. When wind does occur at Rome, dur- 
ing the winter and spring, it is generally from the north, (Tramon- 
tana,) and is very moderate, at least when it continues for any 
considerable time. From this quarter there are occasional storms 
of cold winds ; but these are of short duration, being limited, with 
surprising regularity to three days. The Tramontana is a dry, 
keen, and irritating wind, resembling in its effects the cold, sharp 
winds of Provence ; and is equally to be guarded against by inva- 
lids, who should not stir out of the house while it blows with much 
force. The southerly winds during the winter and spring do not 
produce great inconvenience to invalids at Rome. Even the relax- 
ing and enervating effects of the Sirocco are not much felt, except 
by the more sensitive, and plethoric among the healthy, and by 
them only, after it has continued to blow for a few days. Debili- 
tated invalids, on the other hand, who suffer from great irritability, 
and a degree of morbid sensibility of body, commonly feel the win- 
ter sirocco pleasant. In its effects on the body this wind is directly 
opposed to the Tramontana. 1 Notwithstanding the character given 
of this wind by Celsus it is the favourite of the modern Romans ; 
and during the prevalence of the winter sirocco they feel the full 
enjoyment of health. In the months of March and April, winds are 
more frequent at Rome ; they set in generally in the forenoon, and 
continue till sunset, when they subside, leaving the nights calm and 
serene. The effects of these keen, spring winds, combined with 
that of a powerful sun, are severely felt by the sensitive invalid ; 
though, as far as I could observe, or learn from the testimony of 
others, in a less degree than at Naples and Nice, and perhaps even 
than at Pisa. 

Diseases. — Among the more prevalent diseases of Rome,malaria 

1 The effects of the Tramontana and Sirocco are thus characterised by 
Celsus : " Aquilo tussim movet, fauces exasperat, ventrem adstringit, urinam 
supprimit, horrores excitat item dolorem lateris et pectoris. Sanum tamen 
corpus spissat et mobilius atque expeditius reddit." — "Austeraures hebetat, 
sensus tardat, capitis dolorem movet, alvum solvit, totum corpus efficit hebes, 
humidum, languidum." — Liber ii. cap. i. 

8* 



116 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

fevers are the most remarkable, and claim our first notice. In the 
few remarks I am about to make on the subject, I shall confine 
myself chiefly to those circumstances respecting malaria, which it 
is impoitant for travellers to know, with the view of enabling them 
to avoid its effects. 

In the first place, I may observe, that the malaria fevers of Rome 
are exactly of the same nature, both in their origin and general 
characters, as the fevers which are so common in the fens of Lin- 
colnshire and Essex, in our own country, in Holland, and in certain 
districts, over the greater part of the globe. The form and aspect 
under which these fevers appear, may differ according to the con- 
centration of the cause, or to some peculiar circumstances in the 
nature of the climate, or season in which they occur ; but it is the 
same disease, from the fens of Lincolnshire and the swamps of 
Walcheren, to the pestilential shores of Africa ; only increased in 
severity, cceteris paribus, as the temperature of the climate increases. 
In England, and in Holland, these fevers generally appear in the 
simple intermittent form ; more rarely in the remittent form; and 
they are, for the most part, easy of cure. In France, especially to- 
wards the south, the same fevers often assume a more formidable 
character. Those which, from their unusual severity, and the 
peculiar character of their symptoms, have received the name of 
pernicious, are by no means uncommon in the southwest of France; 
and in the rice districts of Lombardy, they are met with in all their 
varieties ; and with a degree of severity, perhaps equal to the more 
aggravated forms of the malaria fevers of Rome. Even in this 
country intermittent fevers occasionally assume the pernicious 
form, and unless medical practitioners in our malaria districts keep 
this in mind, patients may be lost before the real nature of the 
disease is discovered. 

Malaria fevers seldom appear at Rome before July, and they 
cease about October ; a period during which few strangers reside 
there. The fevers of this kind which occur at other seasons are 
generally relapses, or complicated with other diseases. One of the 
most frequent exciting causes of this fever, is exposure to currents 
of cold air, or chills in damp places, immediately after the body has 
been heated by exercise, and is still perspiring. This is a more 
frequent source of other diseases also, among strangers in Italy, 
than is generally believed by those who are unacquainted with the 
nature of the climate. Exposure to the direct influence of the sun, 
especially in the spring, may also be an exciting cause : it has cer- 
tainly appeared to me to produce relapses. Another cause of this 
disease is improper diet. An idea prevails, that full living and a 
liberal allowance of wine, are necessary to preserve health in situa- 
tions subject to malaria. This is an erroneous opinion; and I have 
known many persons suffer in Italy from acting on it. A deranged 
state of the digestive organs is generally the consequence of this 
regimen; and under such circumstances the individual is much 
more liable to disease of every kind. Irregularities in diet are one 



CLIMATES OF ITALY. 117 

of the most frequent exciting causes of malaria fever among the 
peasantry about Rome, who are the principal sufferers from it. A 
plain and moderate diet, as it is the most conducive to health gene- 
rally, so it must, in the present case, best aid the constitution in 
resisting the cause of this fever. If there is any one circumstance 
in the state of the constitution, which more than another enables it 
to combat and to pass through disease, it is, according to my ob- 
servation, a healthy condition of the digestive organs. In every 
situation of life, at all ages, and in every climate, this holds true. 

In regulating the diet of persons living in a malaria country, 
regard should be had to the nature of The climate. The same 
stimulating regimen which might be borne, and even prove useful, 
in the damp, chilly atmosphere of Holland, will not be suited to the 
exciting climate of Italy. The peasantry in some parts of Italy are 
very sensible of this. Sleeping with open windows, either during 
the day or night, more especially in places subject to these fevers, 
is very dangerous ; and I have known repeated instances of fever 
produced in this way. Towns are always safer than villages, and 
the latter than country houses ; and the central parts of a town 
again are safer than the suburbs. 

Much has been said about the healthy and unhealthy quarters of 
Rome ; and in this respect there certainly is a material difference in 
the summer ; but in the season during which strangers reside there, 
this circumstance demands much less consideration. More is to be 
feared from currents of cold air in the winter, than from a confined 
humid atmosphere, which last is the evil to be avoided during sum- 
mer. This circumstance, respecting the effects of different seasons, 
requires attention, inasmuch as a residence that may be very proper 
during the winter, may not be so in summer. 

It may be stated, as a general rule, that houses in confined, shaded 
situations, with damp courts or gardens, or standing water close to 
them, are unhealthy in every climate and season : but especially in 
a country subject to intermittent fevers, and during summer and 
autumn. The exemption of the central parts of a large town from 
these fevers is explained by the dryness of the atmosphere and by 
the comparative equality of temperature which prevails there. 
Humid, confined situations, subject to great alternation of tempera- 
ture between day and night, are the most dangerous. Dryness, a 
free circulation of air, and a full exposure to the sun, are the mate- 
rial circumstances to be attended to in choosing a residence. Of all 
the physical qualities of the air, humidity is the most injurious to 
human life; and, therefore, in selecting situations for building, 
particular regard should be had to the circumstances which are 
calculated to obviate humidity either in the soil or atmosphere. A 
person may, I believe, sleep with perfect safety in the centre of the 
Pontine Marshes, by having his room kept well heated by a fire 
during the night. 

Persons attacked by this fever should be strictly confined to the 
house until the disease has been completely checked ; after which, 



118 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

the sooner they change the air, the more likely will they be to avoid 
relapses, and to prevent a disposition to a return of the disease from 
being fixed on the constitution — a circumstance of great conse- 
quence to the future health of the individual. During the autumn 
or winter, such persons may go to Naples ; but if the spring is far 
advanced, Florence will be the better place. 

The next circumstance connected with the diseases of Rome, 
which deserves notice, is the peculiar sensibility of the nervous 
system of its inhabitants. This is evinced, in a very particular 
manner, by the disposition to convulsive affections, and the singu- 
lar sensitiveness of the Romans, especially the females, to perfumes. 
This peculiar susceptibility of the nervous system, appears to be of 
recent origin. We learn from ancient authors that the Roman 
matrons were fond of perfumes ; and as the circumstance is not 
mentioned by the Roman medical authors who have more recently 
written on the climate and diseases of Rome, for instance, Petronio, 
Baglivi, Marsilio Cagnato, and Lancisi, there can be little doubt 
that it did not exist in their time. It is to be remarked, that it is 
not disagreeable odours which produce such effects on the nervous 
system, but the more delicate, and, to northern nations, agreeable 
odours of flowers, and other perfumes. Headaches, and numerous 
other nervous affections, are produced by such odours. 

The Roman physicians, who agree in the recent growth of this 
morbidly sensitive state of the nervous system among the inhabi- 
tants of Rome, cannot fix upon any other circumstance, to which it 
can be fairly attributed, except the indolent manner of life of the 
Romans, which favours, especially in such a climate, the relaxation 
and sensibility of the system. Thus Dr. De Matthaeis, after remark- 
ing that powerful odours have at all times produced sensible effects 
on the system, observes, that "there is nothing wonderful in this, if 
we consider the daily increasing mobility of the nervous system, 
produced by the luxurious and inactive life of our Romans." 1 Such 
most likely was the source of this idiosyncrasy, and no doubt still 
tends to maintain it ; while the morbid sensibility of the nervous 
system, once acquired, is, doubtless, transmitted from parent to 
child. But though much may depend on the effeminate and indo- 
lent manner of living at Rome, the climate, I believe, has some 
specific effect in inducing this state of the nervous system. The 
habits of the Romans differ little from those of the inhabitants of 
the other large towns in Italy, for instance, Naples, Florence, 
Genoa, &c. : and yet this morbidly sensitive state of the nervous 
system does not exist, by any means, in the same degree, in these 
places. Even a temporary residence of some duration in Rome, 
produces a degree of the same morbid sensibility, and that in cases 
where the Roman mode of living cannot be adduced as the cause. 

Another disease, or rather class of diseases, of much more serious 
character, but also, in a great degree, of modern origin, is particu- 

1 De Matthaeis Ratio Instituti Clinici Romani. 



CLIMATES OP ITALY. 119 

larly frequent among the Romans, under the name of Accidente, 
and speedily proves fatal. Apoplexy and other diseases of the brain, 
and diseases of the heart and large blood-vessels, are, I believe, the 
most frequent causes of these sudden deaths, and originate partly in 
the same sources as the nervous affections we have already noticed ; 
as do likewise the capiplenium, languor, and expletio, which Pe- 
tronius remarks as morbid dispositions particularly common among 
the Romans of his time. 

Inflammatory affections of the chest rank next, in point of fre- 
quency, among the diseases of winter and spring at Rome. Acute 
inflammation of the lungs appeared to me more violent and more 
rapid in its course, than in England and other northern countries. 
This remark does not apply to Rome only, but I believe to the 
whole of Italy, and to warm climates generally. When at Dresden, 
the late celebrated German physician, Dr. Kreysig, remarked to me 
that he had never witnessed such violent cases of pneumonic inflam- 
mation in Germany, as he saw during his stay at Pavia. In Rome, 
the obstinacy and mortality of pulmonary diseases are greatly in- 
creased, by their frequent complication with enlarged and otherwise 
diseased abdominal viscera, the consequence of malaria fever. 

Pure tubercular consumption is not of very frequent occurrence 
at Rome, the greater number of chronic affections of the lungs 
being the effect of inflammation. These occur chiefly among the 
lower classes, who are badly clothed during the winter, and many 
of whom are predisposed to such affections from having already 
suffered from repeated attacks of intermittent fever, which have left 
behind them obstructions of the abdominal viscera. 

Headaches are common at Rome, and among strangers I found 
them of very frequent occurrence. On the other hand, I met with 
several instances of habitual headaches in young persons disappear- 
ing during a residence there. In some cases the headaches were of 
the pure nervous character, but a large proportion of them originated 
in errors of diet, and were generally remedied by avoiding these. 
Persons subject to this complaint, especially if it is connected with 
irritation of the stomach, should be particularly careful of their diet 
at Rome, where, owing to the greater sensibility of the nervous 
system, slighter causes produce headache than in this country. 

Among the diseases benefited by a residence at Rome. I may rank 
consumption. In the early stages of this affection, I have generally 
found the climate favourable. I have frequently known patients 
who had left England labouring under symptoms that gave much 
and just alarm, and which continued during the whole journey, get 
entirely rid of them after a short residence in Rome. The same 
persons have remained comparatively free from all bad symptoms 
during the whole season ; and this, when from the ultimate result 
of the case, there could be no doubt of the existence of tuberculous 
disease at the time. 1 In the advanced stages of consumption, the 

1 Dr. Carlyle, who resided six winters at Rome, writes me, that he was 



120 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

climate produced no benefit, the dispase generally proceeding in the 
usual course, often more rapidly (especially during the spring 
months) than it would have done in England. 

In bronchial affections the climate is very generally beneficial, 
especially in cases where there prevails great irritability of the 
bronchial membrane, with much sensibility to harsh, cold winds. I 
have known many such patients express themselves as feeling much 
better at Rome than at Nice, or any of the other places where they 
had resided. Nothing was more common than to meet with bron- 
chial diseases, w T hich. after having been benefited by a short resi- 
dence at Rome, were greatly aggravated by a visit to Naples, and 
again relieved by the return to Rome. In chronic bronchitis, 
indeed, more especially when the disease was of the dry irritable 
kind, or w r as complicated with irritation of the digestive organs, a 
residence at Rome^produced the best effects: and in cases of this 
kind I consider it the most favourable residence on the Contineut. 

Chronic Rheumatism is generally much relieved : but as this 
disease is very frequently consequent to, or connected with, a dis- 
ordered state of the digestive organs, it is necessary to take into 
account the particular form of dyspepsia, before sending a rheumatic 
patient to Rome. See the article on "Rheumatism."' 

With persons disposed to apoplexy, or who have already suffered 
from paralytic affections, and valetudinarians of a nervous, melan- 
cholic temperament, or subject to mental despondency, the climate 
of Rome does not agree ; and in many such cases, indeed, a resi- 
dence at Rome is fraught with danger ; nor is it proper for persons 
disposed to hemorrhagic diseases, or for those who have suffered 
from intermittent fevers. 

No city in the south of Europe frequented by invalids, affords 
greater facilities for exercise in the country than Rome. In the 
variety and extent of its rides it exceeds every other large city I 
have visited on the Continent. This circumstance, and the imme- 
diate vicinity of the public walks to that part chiefly occupied by 
strangers, renders Rome a far less objectionable abode for invalids 
than the generality of large towns. The Piazza di Spagna, and 
streets in that vicinity, afford the best residences. The street 
run in an easterly and westerly direction are to be preferred to those 
running north and south, as they are less exposed to currents of cold 
air during the prevalence of northerly winds, and the houses have 
a better exposure. Both the sitting and bedrooms of delicate inva- 
lids should, if possible, have a southern aspect. I had the tempera- 
ture of several bedrooms noted in the night, and early in the 
morning, and found considerable difference between those exposed 
to the north and south. Nervous persons should live in the more 
open and elevated situations. 

struck with the remarkable influence of the climate in preventing the develop- 
ment, and checking the progress of tubercular disease in young persons of a 
strumous constitution. 



CLIMATES OF ITALY. 121 

Besides care in the selection of apartments, there are other cir- 
cumstances which require peculiar attention from the invalid re- 
siding at Rome. There is no place where so many temptations 
exist to allure him from the kind of life which he ought to lead. 
The cold churches, and still colder museums of the Vatican and 
the Capitol, the ancient baths. &c. are full of danger to the delicate 
invalid : and if his visits to these be long, or frequently repeated, he 
had better have remained in his own country. When an invalid 
does venture into them, his visit should be short, and he should 
choose for it a mild warm day. It is a grievous mistake to imagine 
that when once in such a place the evil is done, and that one may 
as well remain to see the thing fully. This is far from being the 
case. A short visit to these places is much less dangerous than a 
long one. The body is capable of maintaining its temperature, and 
of resisting the injurious effects of a cold damp atmosphere for a 
certain length of time with comparative impunity. But if the inva- 
lid remain till he becomes chilled, and till the blood forsakes the 
surface and extremities, and is forced upon the internal organs, he 
need not be surprised if an increase of his disease, whether of the 
lungs or of the digestive organs, be the consequence of such expo- 
sure. Once, and again, these visits may be made without any 
evident mischief: but sooner or later their evil effects will be mani- 
fest, as I have very often witnessed. The invalid, unwilling to 
admit the real cause in such cases, is too apt to impute to the 
climate, that which in truth arises from his own imprudence and 
indiscretion, in exposing himself to causes which are not necessarily 
connected with the climate. Excursions into the country, when the 
warm weather of spring commences, particularly when made on 
horseback, is another and a frequent source of mischief to delicate 
invalids. 

The invalid should arrive at Rome in October, and if the chest 
be the part affected, and he is still very sensible to the spring winds, 
the beginning of May will be sufficiently early for him to leave it. 
After this time he should move northwards, being guided by the 
weather as to the period of crossing the Alps ; though this should 
scarcely be done before the middle, or end of June. About the 
Lago Maggiore, or Lago di Como. the invalid may pass a week or 
two, if the weather is such as to render it prudent for him to delay 
crossing the mountains. The Simplon at this season is the best 
route from Italy to Switzerland. 

NAPLES. 

In its general characters the climate of Naples resembles that of 
Nice more than any other. As at Nice, the autumn and winter are 
generally mild, and the spring is subject to cold, sharp, irritating 
winds, rendered more trying and hurtful to invalids by the heat of 
a powerful sun. The climate of Naples is much more changeable 
than that of Nice ; and, if somewhat softer in the winter, it is more 



122 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

hnmid. The sirocco, which is little known at Nice, is severely felt 
at Naples. The mean annual temperature is higher than that of 
Rome, Pisa, or Nice ; but the annual range of mean temperature is 
very considerable, being 30°, whilst that of Nice is but 28° ; and that 
of Rome only 26°. The distribution of temperature in the different 
months is more unequal than at Nice or Rome. The daily range 
of temperature is also very great, being 2° more than at Rome. 
The temperature likewise varies very much from day to day, as 
will appear from the following statement : — The mean variation of 
successive days at Naples is 3° 36 ; at Rome it is 2° 80; at Nice 
2° 33. The annual range of atmospheric pressure is very small — 
somewhat less than at Rome, and very considerably less than in the 
Southeast of France. Rain falls less frequently at Naples than at 
Rome. 

Of the diseases of the inhabitants of Naples, catarrhal affections 
are the most common. Consumption is not very frequent, nor in 
general rapid in its course : autumn is said to be the most fatal sea- 
son to the consumptive. Rheumatism is very frequent. Nervous 
affections are also common, as are cutaneous eruptions, and diseases 
of the uterine system. Naples is not subject to any endemic disease, 
although intermittent fever is not unfrequent in some places in the 
outskirts of the city. Inflammation of the eyes is very prevalent. 

Of Naples as a residence for invalids it is unnecessary to say 
much. Consumptive patients should certainly not be sent there. 
The qualities which have been pointed out in its climate, sufficiently 
mark it as a very unsuitable residence for this class of invalids ; and 
to the list of its defects must be added that of its topographical posi- 
tion, which affords no proper places for exercise, without such ex- 
posure as would prove highly injurious to delicate invalids. For 
chronic rheumatism the climate is certainly inferior to that of Nice 
and Rome. Naples is, however, well suited as a winter residence 
for those who are labouring under general debility and deranged 
health, without any marked local disease. The beauty of its situa- 
tion, the brilliancy of its skies, and the interest excited by the sur- 
rounding scenery, render it a very desirable and very delightful 
winter residence, for those who require mental amusement and 
recreation for the restoration of their general health, rather than a 
mild, equable climate for the removal of any particular disease. 

With respect to choice of situation in Naples, invalids with whom 
a warm and rather close atmosphere agrees, will find themselves 
best in the Borgo di Chiaja, Vittoria, or Chiatamone. For patients 
labouring under nervous dyspepsia, and for nervous invalids gene- 
rally, the Largo del Castello, Pizzo Falcone, and Santa Lucia, 
afford more favourable residences. 

The Neapolitan physicians generally condemn the vicinity of the 
sea in consumptive cases, and think such patients do better in the 
more sheltered places behind the town, and in the neighbourhood 
of the Studio; but here strangers do not reside. Of the situations 
frequented by strangers, the Borgo di Chiaja and Chiatamone afford 



CLIMATES OF ITALY. 



123 



altogether the best residences for pulmonary invalids. These situa- 
tions are fully exposed to the south, and pretty well sheltered from 
the north; while their immediate vicinity to the public gardens 
(Villa Reale) is convenient for walking exercise. But, as I have 
already observed, Naples is altogether an unsuitable residence for 
pulmonary invalids. 

MALTA. 

Malta is in the 36th degree of north latitude, and at a greater 
distance from the mainland than any other island in the Mediter- 
ranean. Its circumference is from sixty to seventy miles, its greatest 
length eighteen miles, and its greatest breadth twelve. Most of the 
southern coast is formed of high perpendicular rocks ; the other 
parts are low and have a very barren appearance. The highest 
ground is, according to Dr. Sankey, something more than 600 feet 
above the level of the sea. 1 

The whole island consists of calcareous rock covered with but a 
scanty mould. Notwithstanding this, the culture which is bestowed 
upon it renders the soil very fertile. There is no intermission of 
vegetation throughout the year. March and April are the months 
in which it is in its most luxuriant state. It is very much burnt 
up during the summer months. 

The surface of the island is diversified by hills of slight eleva- 
tion, and vales. There is neither river nor lake, but numerous 
springs exist in different parts of the island. 

The range of the thermometer during the month of October, 
November, December and January, on the average of five years, 
from 1830 to 1835 was as under : — 



Maximum, 
Medium, . 
Minimum, 



Oct. 


Nov. 


Dec. 


Jan. 


77 

70i 

64 


69 
65 
61 


63i 

59 

54^ 


61 

56-| 

53 



Rain is of very rare occurrence in Malta during the summer; 
but it falls in spring and autumn with tropical violence. The 
autumnal rains usually last from the middle of September to the 
middle of October. Rain falls most heavily during the night. 
Very rarely does the rain continue for several days in succession. 
There is occasionally hail, but never snow. Heavy falls of dew 
occur sometimes during the summer. Fogs are rare at any season. 

The wind which has procured a bad name for Malta with stran- 
gers, is the southeast, commonly called Sirocco. It is a hot, humid, 



1 Malta considered with reference to its eligibility as a Place of Residence 
for Invalids. 



124 CLARK ON THE SANATIVE INFLUENCE OP CLIMATE. 

and disagreeable wind. In winter it is not frequent, and never 
oppressive. It is most prevalent in the beginning of September. 
Strangers in general are affected during the prevalence of the 
sirocco with great lassitude and debility. Persons with diseased 
lungs suffer more or less from it ; but, says Dr. Liddell, " I am 
not aware of any mischief that it produces in the healthy constitu- 
tion beyond the temporary discomfort that it occasions." 

The climate of Malta may be considered pretty equable, the 
range of temperature during the twenty-four hours seldom exceed- 
ing 6°. The air is almost always dry and clear. Gales of wind 
are not frequent, but Malta may be said to be a windy place, parti- 
cularly in spring. Thunder storms are common during the rainy 
season. The fall of rain is supposed to be about fifteen inches. 

Dr. Liddell's account of the winter climate of Malta is very 
favourable. From the middle of October to the middle of January 
he thinks it can scarcely be surpassed. The weather is delightful, 
with the exception of an occasional gregale, or northeast wind, 
which is so chilling, that during its existence, invalids should either 
stay at home or seek the most sheltered walks or drives. During 
the period mentioned, the atmosphere is generally clear, and the 
weather moderate ; and the island is usually fanned by the agree- 
able northwest wind, that sweeps along the channel of Malta, over 
a sea at the temperature of 72°. ' 

Towards the middle of January the weather becomes unsettled ; 
February and March are usually boisterous and rainy ; April, as 
elsewhere, is proverbially variable ; and before June, phthisical 
patients should leave the island to avoid the sultry summer heat. 

The diseases in which Dr. Liddell has observed the climate of 
Malta serviceable, in conjunction with the important preliminary 
sea-voyage to it, have been asthma connected with chronic bron- 
chitis — scrofulous swellings and eruptions, dyspepsia and hypo- 
chondriasis, and that atrophy and disordered state of health, which 
are induced by over-active therapeutics. He considers the climate 
to be peculiarly conducive also to the health of the aged. Dr. 
Sankey has found it beneficial in chronic rheumatism. The mor- 
tality amongst Maltese children is enormous, from their scanty and 
improper food ; but the Maltese women, when well fed, make ex- 
cellent wet nurses, and the English children that are reared by 
them, or by their own mothers, thrive remarkably well in Malta. 
The diseases of children, such as measles, scarlet fever, and hoop- 
ing cough, are comparatively mild. 

When phthisis pulmonalis occurs among the English at Malta, 
Dr. Liddell thinks it is more rapid in its course than in England. 
In regard to its frequency among the Maltese, the late Dr. Hennen, 
according to Dr. Liddell, fell into an error, which has been per- 
petuated in the Army Medical Reports. It is the confounding of 

1 The temperature of the sea, at the depth of ten oi twelve fathoms, was 
ascertained by Capt. Smyth to be 73° to 76° during the year. 






CLIMATES OF ITALY. 125 

pulmonary consumption with Maltese consumption, a disease which 
has no necessary reference to the lungs. Instead therefore of six 
per cent., cases of phthisis pulmonalis, according to Dr. Liddell's 
tables, do not exceed three per cent. 1 

The immunity of Malta from any endemic disease, the ordinary 
good health enjoyed by the natives, and by the English, as well as 
by persons from other countries resident there, and the actual state 
of the weather throughout the year, have given a character for 
salubrity to the climate. But from the statistical tables of Major 
Tulloch, it appears, that even as regards the indigenous inhabit- 
ants, Malta is by no means so healthy as Britain. It seems to enjoy 
only the average salubrity of the states of the south of Europe. 

Strangers reside chiefly in Valetta, the capital of Malta, which 
is one of the finest towns in Europe. It is built on a declivity 
sloping from south to northeast. The principal streets run north 
and south, and are swept by the cold northerly winds. The houses 
are excellent, and the rooms large and lofty. 

In Valetta, the inns are numerous and good ; and there is no 
longer any difficulty in finding commodious lodgings, with Turkey 
carpets on the stone flooring, fires, and other English comforts. 
Country houses, with gardens and orange groves, may be readily 
obtained at short distances from the city. The markets are plenti- 
fully supplied, and at moderate prices. Valetta is abundantly pro- 
vided with excellent water, brought from a spring six miles off" by 
an aqueduct. The other places in the island are mainly supplied 
by rain water collected from the flat roofs of the houses, and kept 
in cisterns excavated from the solid rock. The principal streets, 
which are kept very clean, are either paved or macadamized, and 
readily dry after rain. The roads leading to the country, and 
round the harbours from Valetta, are kept in good condition, but 
they are of no great extent or variety. Saddle horses, and close or 
open carriages, can always be obtained at moderate prices ; and 
there are few entire days in the winter without some hours of sun- 
shine, in which delicate invalids, suitably clothed, may not take 
exercise with advantage in the open air, on foot, on horseback, or 
in a carriage. The Maltese boats are clean, commodious, and safe, 
and will be found, during the numerous calm and mild days of 
winter, to be the most agreeable vehicles for conveying delicate 
invalids round the harbours and fortifications, in which the great 
interest of Malta consists. The most desirable places in Valetta, 
for a winter residence, are those with a southern and eastern aspect, 
near the Barraccas, looking towards Floriana, or into the great 
harbour in Strada Levante. 

Casal Lia, about three miles from Valetta, is, in Dr. Liddell's 
opinion, unexceptionable as .a residence for phthisical invalids. It 

1 The investigations at present in course by my talented friend Dr. Gal- 
land, Professor of Anatomy and Clinical Surgery in the University of 
Malta, will soon set this question at rest. As far as they have been carried 
they support the opinion of Dr. Liddell. 



126 CLARK ON THE SANATIVE INFLUENCE OP CLIMATE. 

is well sheltered, and is contiguous to the public garden of Sant 
Antonio. This extensive garden has a southeastern aspect, and is 
surrounded by a high wall, and the walks, which are paved with 
stone, speedily dry after rain. But with all these advantages, Dr. 
Liddell fears that suitable accommodation, with good English com- 
forts for invalids, could not be obtained in Casal Lia, although the 
houses are generally large and good. 

11 No place," Dr. Liddell sums up, " that I have seen in the south 
of Europe, can, I think, compete with Malta, for a mild, dry, brac- 
ing air, in November, December, and part of January ; and, during 
the other winter and spring months, I think, it is equal to any of 
them. I have been at them all in winter, except Nice." 1 

There are doubtless on the shores and among the islands of the 
Mediterranean, situations possessing climates equal to those of the 
places which have been noticed ; but we are not sufficiently ac- 
quainted with their characters, and they are mostly deficient in 
those requisites which are as essential to an invalid as climate. In 
giving an account of the best climates of the Mediterranean, we 
have had in view the wants of the more delicate class of invalids. 
To those who are sent abroad for the prevention of disease, and 
the improvement of their health, the whole shores and islands of 
the Mediterranean are open. They may visit the south coasts of 
Spain, Sicily, the Ionian Islands, Greece, Syria, and Egypt ; and, 
if their tour is conducted with judgment and discretion, their 
health may be more improved than by residing at any one of the 
climates mentioned. But the more delicate invalid must rest satis- 
fied with such limited changes as have been pointed out in the 
preceding pages. 2 



SUMMER RESIDENCE ON THE CONTINENT. 

For invalids who require to pass several winters on the Conti- 
nent, it becomes a matter of importance to select a place where 
they may spend the intervening summers with the greatest advan- 
tage to their health. For those invalids who have passed the winter 
in Italy, two plans present themselves— either to recross the Alps, 
or to select the most favourable situation in that country. By the 
first, the invalid will escape the oppressive heat of an Italian sum- 
mer ; by the latter, he will avoid the inconveniences of a long 
journey. In deciding between these, in individual cases, various 

1 In drawing up the preceding account of Malta, I have been much in- 
debted to the valuable communications from Dr. Liddell, who was physi- 
cian to the Royal Naval Hospital in that island for twelve years, and whose 
statements and opinions are deserving of the utmost confidence. I would 
here also acknowledge my obligations to the sensible pamphlet by Dr. 
Sankey, already referred to. 

2 See article Pulmonary Consumption, p. 30. 



SUMMER RESIDENCE ON THE CONTINENT. 127 

circumstances will require to be considered, which admit of being 
noticed here only in a very general manner. 

Consumptive invalids will do well to quit Italy ; and I may ob- 
serve that I comprehend in this class, not only those actually 
labouring under phthisis, but all such as are threatened by it. The 
summer heat of Italy will disagree with both — in proportion to the 
advanced period of the disease in the former, and to the deranged 
state of the general health in the latter. In both cases we generally 
find a weak and relaxed state of the constitution, accompanied) 
very often, with a morbid sensibility of the nervous system, in 
which great heat is always injurious. And when symptomatic 
fever or morning perspirations have shown themselves, these 
afford still stronger reasons against a summer residence south of 
the Alps. 

Among this class of invalids some exceptions may, however, be 
found. Torpid constitutions, in which there is little nervous sensi- 
bility, and little disposition to febrile excitement, with a defective 
state of the cutaneous secretions, and a rigid rather than a relaxed 
state of fibre, may even derive advantage from a summer passed in 
one of the more healthy situations in Italy. 

But the greater number of invalids who have derived benefit 
from the Italian climate, during the winter, will do well to quit it 
in the summer. This remark will apply more especially to those 
who labour under diseases of the nervous system, depending upon, 
or connected with, cerebral congestion ; indeed, very few of this 
class of invalids should venture to pass even the winter in Italy, 
without carefully adapting their regimen to the nature of the cli- 
mate. Likewise, in cases of irritation of the mucous membrane of 
the digestive organs, and in congestions of the abdominal viscera, 
with a deranged state of the functions of the liver, or a disposition 
to dysentery, the whole south of Europe will disagree during the 
summer. 

The places principally resorted to by invalids, who pass the sum- 
mer in Italy, are Naples, and its vicinity; Sienna, and the Baths 
of Lucca. These are the most eligible summer residences south 
of the Apennines : nor am I aware that any place superior to them 
in point of climate, and possessing the necessary accommodations 
for invalids, is to be found in the north of Italy. 

The Vomero and the Capo di Monte, in the immediate vicinity 
of Naples, afford good situations for summer residences. Of the 
more distant places, Sorento, Castelamare, and the island of Ischia 
are the best. Sorento appears to be the coolest of these ; for which 
it is chiefly indebted to its peninsular form, being a long narrow 
strip of land, having the bay of Naples on one side, and the gulf 
of Salerno on the other. 

Castelamare partakes more of the climate of the Apennines, and 
affords also their usual shelter of chestnut trees. The air is less 
dry than at Sorento. From its northwestern aspect, and the moun- 
tains which rise immediately behind it, this place enjoys a long 



128 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

morning shade ; but its full exposure to the setting sun renders the 
evenings often oppressively hot. 

At Cava, between Naples and Salerno, the air is said to be drier 
and cooler than at any of these places. 

Sienna affords a healthy summer residence for persons who are 
not very liable to suffer from rapid changes of temperature, for such 
often occur here during the summer, owing to the high and ex- 
posed situation of the place. Sienna is considerably cooler in the 
summer, and much colder in the winter, than Naples, Rome, or 
Pisa. The mean annual temperature is 55°.60 ; being 6° less than 
Naples, and only about 5° more than London ; but this arises from 
the coldness of its winter, which is only l°.38 warmer than that of 
London. Its summer temperature is about the same as that of 
Capo di Monte at Naples, but 3° warmer than that of the Baths of 
Lucca. Its daily range of temperature is very great. It is a dry 
and healthy climate, and altogether a safe summer residence ; and 
for nervous relaxed people, it forms a better summer retreat than 
either Naples or the Baths of Lucca, and like the latter place is 
exempt from mosquitoes. For persons disposed to, or labouring 
under pulmonary disease, however, Sienna is an unfavourable cli- 
mate, at all seasons. 

Baths of Lucca. — This little watering place, situated among the 
Apennines near Lucca, is much frequented during the summer ; 
partly on account of its mineral waters, but more on account of the 
coolness of the situation. This last quality is its chief attraction 
to strangers. The mean temperature of the summer here is only 
about 6° higher than the summer of London. In the middle of the 
day, however, the heat is often oppressive ; but the evenings and 
nights are cool and pleasant, and there are no mosquitoes. June, 
July, and August, constitutes the proper season at this place. 
Earlier than June, and after August, the air is damp, and unsuit- 
able to delicate people. There is some variety of situation ; the 
Bagni Caldi are on the brow of a high bill; the Bagni alia Villa 
are partly on the declivity of a hill, and partly on a plain ; and the 
Pont' a Seraglio is in a valley on the banks of the little river Lima. 
The Bagni Caldi is the driest situation, and, when protected from 
the sun, also the coolest. The vicinity of the Bagni alia Villa is 
warmer, but quieter and more retired. The accommodations, 
which have been greatly extended of late years at all these places, 
are pretty good. 

The rides on horseback about Lucca are beautiful and varied ; 
but there is only one or two drives for those who require carriage 
exercise. 

The preference to be given to any one of the places mentioned, 
will depend upon the particular circumstances of the case. Where 
sea-air is known to agree well, and where passive exercise on the 
water, or sea-bathing are advisable, some of the cooler situations 
in the neighbourhood of Naples afford the best residences. On the 
other hand, where there is much nervous sensibility, and when the 



SUMMER RESIDENCE ON THE CONTINENT. 129 

effects of the sirocco are likely to prove injurious, Naples and its 
vicinity ought to be avoided. The Baths of Lucca and Sienna 
should be preferred by such invalids, particularly the former, which 
is a very delightful summer residence. 

The accommodations for strangers at Sorento and Castelamare 
have been greatly increased of late years — walks and drives formed, 
and bathing machines constructed. An English physician generally 
resides at these places during the summer. 

The island of Ischia is also resorted to as a summer residence, 
and it may deserve a preference by some invalids, on account of 
its mineral waters. These are very abundant ; indeed almost all 
the water of the island is more or less thermal, and mineralised. 
Dr. Adair Crawford, who resided a summer in Ischia, found that 
the heat during the day was moderated by regular sea breezes, and 
that the nights were very pleasant. 

Switzerland. — Although I have not hesitated in advising inva- 
lids generally, and consumptive patients in particular, to quit Italy 
during the summer, I do not feel the same confidence in pointing 
out an unexceptionable residence elsewhere, more especially for 
the latter, during that season. Switzerland in point of convenience 
certainly affords one very eligible ; but much caution and prudence 
are required on the part of invalids labouring under pulmonary 
affections who remain there. The alternations of temperature are 
rapid and very considerable. The difference between the day and 
night is great, and there is often a sharpness in the air which proves 
irritating to sensitive invalids. 

Invalids may pass the summer in Switzerland with safety, pro- 
vided they use ordinary prudence, and are careful to avoid unne- 
cessary exposure to the vicissitudes of the weather. They should 
also content themselves with such excursions only as do not cause 
them to be over-fatigued, or heated at one moment, and exposed, 
while in a state of perspiration, perhaps, to a cold breeze the next ; 
a thing which is constantly occurring during mountain excursions 
iu Switzerland. They should neither take long fatiguing walks, 
nor climb steep mountains. They must not attempt to do every 
thing, and see every thing, like their more robust and healthy 
friends. In a word, they should not for a moment lose sight of the 
great object for which they are abroad, viz., the preservation and 
improvement of their health. Severe attacks of fever, and other 
acute diseases, are not uncommon consequences of imprudence of 
the kind alluded to, even among the most robust. 

It will not, I hope, be supposed from any thing now stated, that 
I wish to throw obstacles in the way of young persons, threatened 
with consumption, taking exercise in the open air. This is so far 
from being my intention, that I think such persons can scarcely be 
too much in the open air. All I wish to inculcate is, that they 
should be careful not to convert the best of all preventives into a 
source of evil. For this class of invalids, riding on horseback is 
of all others the most favourable. I am convinced from experience, 
2— b 9 dark 



130 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

that frequent and gentle motion through a mild atmosphere is one 
of the most soothing and invigorating measures which we possess 
for allaying an irritated and congested state of the mucous mem- 
branes of the lungs, and improving the general health. 

The borders of the lake of Geneva afford, I think, the best situa- 
tions for a summer residence in Switzerland ; and the neighbour- 
hood of Geneva is altogether the least exceptionable. Vevey is 
very hot during July and August. The higher situations about 
Lausanne are exposed to the north winds, especially the cutting 
Bise, which frequently blows in the evenings and nights after the 
hottest days of summer, producing a great and often sudden change 
of temperature. The low grounds between Lausanne and the lake 
are close and hot. 

The subjects of pulmonary affections, who pass the summer in 
Switzerland, may try the effects of a course of grapes, " Cure de 
Raisins" a remedy, as already remarked, in high estimation in 
several parts of the Continent ; but on this point the invalid will, 
of course, be directed by a physician on the spot. 

I cannot close these few remarks on the choice of a summer resi- 
dence without recalling the attention of the reader to the cautions 
I have already given on the subject of traveling. Unless a journey 
in hot weather is conducted with great circumspection, the irrita- 
tion and excitement arising from it in susceptible systems, especially 
where any organ is in a state of chronic disease, however slight in 
degree, will do more mischief than any advantage that can be 
derived from a short residence in the best climate, or from the use 
of the most valuable mineral waters. It will be more advisable for 
such an invalid to remain quietly in a situation, even though not 
the most suitable to him, (but the inconveniences of which may, 
in a great measure, be obviated by prudence) than expose himself 
to the danger of having his disease increased by a journey in hot 
weather. 



ATLANTIC CLIMATE. 

Various islands in the Atlantic have been recommended as 
affording favourable winter retreats for invalids; Madeira, the 
Canaries, and the Azores, in the Eastern, and the Bahamas and 
Bermudas in the Western Atlantic. 

It is to be remarked, that the climate of North America differs 
materially in its physical characters from that of Europe and Africa. 
The range of temperature is much greater ; the changes more 
rapid and extensive ; the summer heat much higher, and the win- 
ter cold much more intense under the same parallels of latitude, on 



ATLANTIC CLIMATES. 



131 



the American shores than on those of Europe. 1 The western is 
also more subject to storms than the eastern Atlantic. We shall 
find a corresponding difference in the climate of the islands under 
consideration, according as they approach the American or African 
Continents. 

EASTERN ATLANTIC. 

The islands of the eastern Atlantic, while they differ consider- 
ably in the physical qualities of their climate, differ still more re- 
markably in their structure, and external conformation, from those 
of the western Atlantic. The latter are low, arid, and mostly 
barren rocks, destitute of springs ; the former, on the contrary, are 
lofty, and abundantly supplied with water, and covered with luxu- 
riant vegetation ; circumstances which, independently of their 
geographical position, influence the climate in a very material 
degree. 

MADEIRA. 



I shall commence my survey of the Atlantic Islands with Ma- 
deira. It is the most important and most frequented by invalids ; 
and the character of its climate being the most fully determined, it 
will serve as a standard by which to estimate the climates of the 
other islands. 

Madeira has been long held in high estimation for the mildness 
and equability of its climate, and we shall find on comparing this 
with the climates of the most favoured situations on the continent 
of Europe, that the character is well founded. 

The mean annual temperature of Funchal, the capital of the 
island, is 64°56, being about 5° only above that of the Italian and 
Provencal climates. This very moderate mean temperature, rela- 
tively to its low latitude, arises, however, from the summer at 

1 The climate of North America is of thai class which BufTon has desig- 
nated Excessive Climates; that is, having exceedingly hot summers, and 
intensely cold winters, consequently an extensive annual range of tempera- 
ture. The following comparison of a few places, having nearly the same 
mean annual temperature in the Eastern and Western hemispheres, will 
suffice to show this : — 



PLACES. 


Mean 

Ann. 

Temp. 


Temp. 

of 
Summer. 


Temp. 

of 
Winter. 


Dili', of 
Winter 

and 
Summer. 


Paris, 

Cambridge, Amer. 


51°4 
50°4 


66°0 
70°5 


38°0 
34°0 


28°0 
36°0 


St. Maloes, .... 
Cincinnati, .... 


54°5 
53°7 


66°0 
72°9 


42°0 
32°9 


24°0 
40°0 


Nantes, ....'. 
New York, .... 


55°6 
53°8 


70°7 
70°2 


42°2 
29°8 


28°4 
40°0 


Bourdeaux, .... 
jPhiladelphia, .... 


56°5 
54°9 


70°7 
73°9 


42° 1 
32°2 


28°6 
41°7 



132 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

Madeira being proportionally cool. For, whilst the winter is 20° 
warmer than at London, the summer is only 7° warmer ; and 
whilst the winter is 12° warmer than in Italy and Provence, the 
summer is nearly 5° cooler. The mean annual range of tempera- 
ture is only 14°, being less than half the range of Rome, Pisa. Na- 
ples, and Nice. The heat is also distributed throughout the year 
with surprising equality, so that the mean difference of the tem- 
perature of successive months is only 2°41 ; this at Rome is 4°39, 
at Nice 4°74, at Pisa 5°75, and at Naples 5°08. 

Whilst there is much equality in the distribution of temperature 
throughout the year, there is not less in the progression of tempera- 
ture for the day, the mean range for the twenty-four hours being 
10° by the register thermometer, while at Rome it is 10°, at Na- 
ples 13°, at Nice 9°, by the common thermometer, which gives the 
extremes observed during the day only. 

The steadiness of temperature from day to day also exceeds that 
of all the other climates. In this respect, it is not half so variable 
as Rome, Nice, or Pisa, and is only about one third as variable as 
Naples. The degree of variableness from day to day at Madeira, 
is l°ll ; at Rome it is 2°80 ; at Nice 2°33 ; and at London 4°01. 

The annual range of atmospheric pressure is also very small, 
being about the same as that of Rome and Naples. 

Nearly the same quantity of rain falls annually at Madeira as at 
Rome and Florence, but at Madeira there are only 73 days on 
which any rain falls, while at Rome there are 117. The rain at 
Madeira falls at particular seasons, chiefly in the autumn, leaving 
the atmosphere, in general, dry and clear during the remainder of 
the year. 

From this comparative view of the climate of Madeira, it must 
be readily perceived, how great the advantages are which this 
island presents to certain invalids over the best climates on the 
continent of Europe. It is warmer during the winter, and cooler 
during the summer ; there is less difference between the tempera- 
ture of the day and night, between one season and another, and 
between successive days : it is almost exempt from keen, cold 
winds, and enjoys a general steadiness of weather to which the 
best of these places are strangers. During the summer, the almost 
constant prevalence of northeasterly winds, especially on the north, 
and the regular sea and land breezes on the south side of the island, 
maintain the atmosphere in a temperate state. The sirocco, which 
occurs two or three times, at most, during the season, and then 
continues for a few days only, (seldom more than three,) some- 
times raises the thermometer in the shade to 90 . 1 With this 
exception, the summer temperature is remarkably uniform, the 
thermometer rarely rising above 80°. In consequence of the regu- 
lar sea-breezes, the heat is not so oppressive as that of the summer 

1 The late Dr. Heineken never knew it laise the thermometer, in the 
shade, above 85°. 



ATLANTIC CLIMATES. 133 

in England often is. Close, sultry days are little known in Ma- 
deira, and there is neither smoke nor dust to impair the purity of 
the atmosphere. Such, indeed, is the mildness of the summer at 
Madeira, that a physician, himself an invalid, who resided for some 
time on the island on account of his health, doubted whether this 
season was not more favourable to pulmonary invalids than the 
winter. 1 

Autumn is the rainy season ; and towards the end of September, 
or the beginning of October, the rains commence, accompanied 
with westerly or southwesterly winds. In November the weather 
clears up, and generally continues fine and mild till the end of De- 
cember. About this time some snow usually falls on the moun- 
tains, and rain at Funchal, attended by northwest winds, and 
the weather continues more or less damp through January and 
February; but fog- is never seen, and even during this, the ivi?iter, 
the thermometer at sunrise is rarely ever found below 50°. 

The spring at Madeira, as at every other place, is the most 
trying season for the invalid, and will require even there a corre- 
sponding degree of caution on his part. In March, winds are fre- 
quent, and April and May are showery. 

The mild character of the climate appears to be accompanied 
with a corresponding degree of health in the inhabitants of Madeira. 
The peasantry, though hard worked and badly fed, are a fine, 
healthy, and robust race. " The lower orders of Madeira," says 
Captain Basil Hall, "appear to enjoy a prodigious advantage over 
the higher classes in personal appearance — a distinction they owe 
no doubt, to those temperate and laborious habits of life, which 
probably they consider as any thing but good gifts of fortune. To 
our superficial glance, at least, the peasantry of that happy island 
seemed amongst the most cheerful people we had yet met with." 2 
This island is almost exempt from the diseases peculiar to warm 
climates, and little subject to many of those which are common in 
more northerly countries. Intermittent and remittent fevers arc 
said never to occur, and continued fevers are rare ; croup seems to 
be unknown ; calculous disorders are very unfrequent. The more 
prevalent diseases are cutaneous affections. Apoplexy is also a 
very frequent disease. Bowel complaints are very common, and 
often fatal ; and dysentery is said to be frequently epidemic ; indeed 
this disease maybe said to be almost endemic, among the labouring 
classes; nor need this excite our surprise, when we consider their 
mode of living, which will be presently mentioned. 

With respect to the prevalence of consumption among the na- 
tives of Madeira, there is a difference of opinion among those who 
have had the best opportunities of observing. " Though so highly 
beneficial in this disease, with the natives of other countries," says 

1 See an excellent paper by the late Dr. Heineken, in the Medical Reposi- 
tory, vol. xxii. 1824. 

2 Fragments of Voyages and Travels, p. 154. First Series. New edi- 



134 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

Dr. Gourlay, " it is not to be concealed that no malady is more 
prevalent here than phthisis, with the natives of the island." 1 Dr. 
Heineken's observation leads him to a contrary conclusion. " It 
has been asserted," says this gentleman, " that no malady is more 
prevalent than phthisis with the natives of Madeira ; but, as far as 
my own personal experience and the result of my inquiries go, I 
incline to a contrary conclusion." 2 

Since the first edition of this work was published, I have made 
particular inquiries respecting the frequency of consumption in 
Madeira, and I am satisfied from the information which I have 
received, that tubercular consumption (with which alone we have 
to do here) is a rare disease, compared with what it is in more 
northern climates. "With respect," says Dr. Renton, " to the ques- 
tion relative to the frequency of consumption among the natives, 
Dr. Gourlay (if he alluded to tubercular disease) has greatly over- 
rated it. Tubercular phthisis occurs more frequently, perhaps, 
than might, a priori, have been expected in such a climate ; and I 
have even known it, in a few instances, sweep off nearly whole 
families. But it is only necessary to take a cursory view of the 
habits and circumstances of the natives, to see that they enjoy a 
singular degree of exemption from a disease, to the ordinary causes 
of which a large proportion of them is constantly exposed." 

The lower classes in Madeira are hard-worked and miserably 
nourished: their food consists chiefly of crude vegetables and hard- 
salted fish ; they are badly clothed, and worse lodged ; their habita- 
tions are low miserable huts, and their beds consist of pallets of 
straw, raised a foot or two only from the ground, damp during nine 
months of the year. That diseases of the lungs should be frequent 
under such circumstances is not surprising; and as these are gene- 
rally neglected, or badly treated, they often prove fatal in a chronic 
form simulating phthisis. But even if tubercular consumption were 
a frequent occurrence under the circumstances which we have 
stated, it would afford no reasonable ground of objection to the 
climate of Madeira, for persons exempted from such palpable causes 
of disease. 

In my inquiries respecting the influence of the climate of Madeira 
on disease, I shall confine myself to consumption, which is, indeed, 
almost the only disease on account of which Madeira has been 
resorted to. As I never resided at this island, I must rely on the 
information and opinions, which I have derived from other sources. 
On this subject, however, I have obtained so much assistance from 
Dr. Renton, who has long resided in the island, and from the late 
Dr. Heineken, who spent the last nine years of his life there, on 
account of a pulmonary disease, that the utmost reliance may be 
placed on the following observations. Both these gentlemen have 

• Observations on the Natural History, Climate, and Diseases of Madeira. 
By William Geurlay, M. D. 1811. 
2 Op. CitaL 



ATLANTIC CLIMATES. 135 

published valuable papers on the climate of Madeira, and its in- 
fluence on consumptive patients. Their opinions regarding the 
propriety of sending such patients, in the advanced stage of the 
disease, to this island, are in perfect accordance with those I pub- 
lished on the subject, with reference to the Continent, twenty years 
ago. 1 And the results of their experience, given below, confirm 
in the most conclusive manner, the principles which are incul- 
cated in this work, respecting the proper period of sending con- 
sumptive invalids abroad. They show the necessity of adopting 
change of climate as a means of preventing, rather than of curing 
consumption. Dr. Renton, in a sensible paper published in the 
Edinburgh Medical and Surgical Journal, 2 makes some judicious 
remarks on the " inutility, not to say cruelty" of sending patients in 
the advanced stages of consumption, to Madeira. 

I give the following interesting and instructive table from Dr. 
Renton's paper. It is drawn up from the cases of which he had 
kept notes, during the preceding eight years. 

Cases of Confirmed Phthisis ... 47 

Of these died within six months after their arrival at Madeira 32 

Went home in summer, returned, and died, ... 6 

Left the island, of whose death we have heard ... 6 

Not since heard of, probably dead 3 



Total 47 

Cases of Incipient Phthisis .... 35 

Of these there left the island much improved, and of whom we 

have had good accounts 26 

Also improved, but not since heard of ... . 5 

Have since died , . 4 



Total 35 

" In the cases marked Confirmed Phthisis, there were copious 
purulent expectoration, diarrhoea, &c., and almost all of them 
terminated fatally. 

" Some of those marked Incipient Phthisis were probably not 
fully entitled to an appellation so ominous. The subjects were 
generally young people who were said to have 'overgrown them- 
selves,' and who had been liable in England to inflammatory attacks, 
having cough, &c. Others had suffered from neglected or mistreated 
inflammation, and in many there was a strong family predisposition 
to pulmonary disease. Most of them, 1 have little doubt, would now 
have been in their graves, but for the precautionary measure which 
was adopted." 

1 See "Notes on the Climate of France and Italy," &c, 1820. 

2 Vol. xxvii. 1817. 



136 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

With respect to the consumptive cases which are likely to derive 
advantage from a residence at Madeira, Dr. Renton further remarks, 
" When "it (consumption) has proceeded to any considerable extent, 
I should consider it the duty of a medical attendant not only not to 
advise the adoption of such a measure, but most earnestly to dis- 
suade from it those who, from hearsay evidence of the recovery of 
persons in circumstances similar to their own, may feel disposed to 
fly to it as a last resource. 

" That great and lasting benefit is to be derived even from a tem- 
porary residence in this climate, which is probably inferior to no 
other in cases where pulmonary disease is merely threatened, or 
where strong family predisposition to it exists, many living exam- 
ples sufficiently prove. But even under such comparatively favour- 
able circumstances, it ought to be strongly impressed on the mind 
of the invalid, that half measures are worse than useless, and that 
no advantage is to be derived from climate, however fine, unless it 
be seconded by the utmost caution and prudence on his part." 

The result of Dr. Heineken's observations is quite in accordance 
with that of Dr. Renton. 

Of the thirty-five cases reported by Dr. Heineken, several died 
before they reached the island, three within a month of their land- 
ing, and five or six in about six months. Of forty-seven cases of 
the same class of invalids in Dr. Renton's report, more than two 
thirds died within six months of their arrival in the island. This 
is a melancholy picture of the progress of consumption under all 
the advantages of the mildest climate ; it shows, in a striking point 
of view, the necessity of discrimination in sending patients to Ma- 
deira, and ought to impress medical men with a deep feeling of the 
heavy responsibility which they take upon themselves in deciding 
on a question of such importance. By far the greater number of 
the patients, above referred to, ought never to have left their own 
country; the advanced period of their disease could leave no rea- 
sonable prospect of benefit from such a measure. 

The result of the cases sent to Madeira at the proper period is 
very different. Of thirty-five cases of incipient or threatened 
phthisis, twenty-six were much improved, and probably a large 
proportion of them were ultimately saved. 

While, therefore, the result of sending patients in an advanced 
stage of consumption to Madeira shows the inutility of such a mea- 
sure, to say the least of it, the effects of the climate in incipient 
cases, and on those threatened with the disease, are highly encou- 
raging, and should lead medical men to recommend such a measure 
at the time only when it promises benefit. 

The following table, for which I am also indebted to Dr. Renton, 
while it shows the same result as regards confirmed cases of con- 
sumption sent to Madeira, exhibits the good effects of sending 
proper cases. It is also satisfactory to see that much the larger 
proportion of cases now sent are of the latter description. 



ATLANTIC CLIMATES. 137 

Number of Consumptive Invalids who have arrived here from 
1st January, 1S3S to 31st May, 1840 ... 182 

With Tuberculous Lungs ... 56 

Died here 30 

Left the island 22 

Still here 4 

56 

Threatened with Pulmonary Disease . 10H 

Remained free from symptoms 93 

Fell off 13 

Lost sight of 2 



10S 



For some time after the publication of the first edition of this 
work, Dr. Ren ton remarked that the proportion of invalids whose 
cases admitted of benefit from the climate was greatly augmented; 
but I have reason to fear that the successful issue of such cases has 
encouraged many to go to Madeira who would have found it better 
to remain at home. 

When we take into consideration the mildness of the winter, and 
the coolness of the summer, together with the remarkable equality 
of the temperature during the day and night, as well as throughout 
the year, we may safely conclude that the climate of Madeira is the 
finest in the northern hemisphere. 

The salubrity of this favoured island also, — its almost total 
exemption from endemic diseases, and the general mildness of the 
ordinary complaints, from which no climate nor situation is exempt, 
contribute to render Madeira a very desirable residence for all inva- 
lids who are in a condition to be benefited by a mild and equable 
climate. 

There is no place on the continent of Europe with which I am 
acquainted, where the pulmonary invalid could reside with so much 
advantage during the whole year as in Madeira. On this subject I 
have already cited Dr. Heineken's opinion, which is of the greater 
weight, as he himself resided in Madeira in consequence of a pul- 
monary complaint. He found that he rather retrograded during 
the winter, but always gained ground during the summer. " Could 
I enjoy for a few years," he observes, " a perpetual Madeira sum- 
mer, I should confidently anticipate the most beneficial effects/' So 
high, indeed, is his opinion of the summer climate of Madeira, that 
he suggests the propriety of pulmonary invalids, who can con- 
veniently accomplish such .a plan, passing the winter in the West 
Indies, and the summer at Madeira. Of the effects of such a plan, 
however, Dr. Heineken does not appear to have had any experience. 

The coolness of the summer at Madeira is a very fortunate cir- 
cumstance for those invalids who ought to pass several winters 



138 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

abroad, which is the case with by far the greater number of con- 
sumptive patients; and for whom it is very difficult to find a good 
situation during the summer on the Continent, even after a long 
and often tiresome journey. When it becomes requisite for a whole 
family to remove to a mild climate, this is a consideration of much 
weight, more especially when the members of such a family are 
chiefly females. In Madeira, the invalid has only to change his 
quarters from Funchal to a more elevated situation in the neigh- 
bourhood ; or go to the north side of the island. This will be found 
a still more favourable summer residence, from its being under the 
influence of the northeast trade wind, which blows constantly there 
during the summer months, and affords a degree of coolness and 
freshness to which the residents on the south side of the island are 
strangers. There is now, in the parish of St. Ann's, an excellent 
house established for the accommodation of strangers, 1 and other 
houses are to be had. Dr. Renton says, :; that from his personal 
knowledge of the place, as well as from the accounts of those who 
have lived there during the three warm months of summer, he has 
no hesitation in saying, that many whom he formerly recommended 
to leave the island on the approach of warm weather, and who 
would in all probability be obliged to return, or go elsewhere, the 
following winter, might have found a comfortable residence there, 
and by returning to Funchal. or its neighbourhood, at the proper 
season, secured the enjoyment of a wonderfully equal temperature 
during the whole year." The invalid may thus be saved a voyage 
or journey, and if he is prudent, he will often find that he has 
gained more in health during the summer than he did in the winter. 
" As a permanent abode, 1 ' says Dr. Heineken, in a written commu- 
nication to me, i: I believe Madeira surpasses every other place, 
because it contains within itself the means of equalising the annual 
temperature more completely than any other spot with which we 
are acquainted. The loicest to which a thermometer exposed all 
night in a north aspect has ever fallen in Funchal during five 
years, is 50°, and the highest to which it will ever rise, at such a 
distance up the mountains as would in every respect suit an inva- 

'This house is described by Dr. Macaulay, ( ;c Notes on the Physical 
Geography, Geology and Climate of the Island of Madeira, in the Edinburgh 
New Philosophical Journal for October, 1840, ,; ) as situated in a district of 
great beauty, rich in plantations, gardens, and vineyards. Between Funchal 
and St. Ann's there is some of the finest scenery of the island. ''Many 
artists, 1 ' says Dr. Macaulay, "have endeavoured to delineate the scenery of 
Madeira; but by far the most successful attempt has been made by Mr. 
Picken, a young artist of great genius, who has resided for several winters 
on the island on account of his health. He has made some admirable paint- 
ings of the principal scenes, including the city of Funchal. To the geologist 
these will give a very good idea of the appearances and physical geography 
of the island, and will be generally interesting as representations of the most 
remarkable natural scenery in the world. :: 

Mr. Picken'3 work is entitled, " Madeira Illustrated ;" and is published by 
Day and Haghe, Gate Street, Lincoln's-Inn-Fields ; London. 



ATLANTIC CLIMATES. 139 

lid. need never exceed 74°. The sirocco visits ns so seldom, and 
its heat may so readily be avoided by closing the doors and windows, 
that it need not be taken into account. The mean annual diurnal 
range is from S° to 10°; but an invalid may with ordinary precau- 
tion, and without the aid of fires, live in a temperature never vary- 
ing within doors more than perhaps 6° throughout the twenty-four 
hours. In a few words. I would say — there is no occasion for a 
person, throughout the winter in Funchal, to breathe, night or day, 
within doors, an atmosphere below the temperature of 64 c ; or in 
the country, and at such a height as to ensure dryness, above that 
of 74° ; that he may during the summer take abundance of exercise 
by choosing his hours without ever exposing himself to oppressive 
heats: and that in the winter he need not be confined to the house 
the whole day either by wet or cold more perhaps than a score of 
times. " ; 

i; I am acquainted with no place," says Captain Basil Hall, -in 
which such a variety of climates may be commanded with certainty 
as in this beautiful island — beautiful in every sense : for the scenery 
is so varied, that almost all tastes may be suited.'' 1 

The foregoing evidence is quite sufficient, I think, to show that 
where climate is likely to be useful in consumption, that of Madeira 
is preferable to any hi the south of Europe ; and Madeira has this 
important advantage over all other places frequented by invalids, 
as I have just remarked, that they may remain there during the 
whole year without suffering from oppressive heat, or being sub- 
jected to the inconvenience of a long journey. When such con- 
sumptive patients only are sent abroad, therefore, as ought to be 
sent, a proportion of them may pass the summer safely, and often 
even with advantage in Madeira, particularly on the northern side 
of the island. But perhaps a larger proportion would suffer from 
the summer heat even of Madeira, or at least would derive benefit 
from a cooler and more bracing air. The latter will generally be 
found among young, growing persons, and more frequently females 
of relaxed constitutions. To the more firm and rigid frame of the 
adult, in whom internal congestion is much more to be dreaded 
than relaxation, the summer at Madeira will often prove more 
beneficial than the winter. 

But how proper soever it may be for an invalid who has passed 
the winter at Madeira to remain there during the summer, with a 
view of spending another winter, — a case will rarely occur in which 
it would be advisable to send a consumptive patient from this coun- 
try to pass the summer in that island. An invalid, however, who 
has passed the winter in the West Indies, probably could not select 
a better situation for his summer residence than Madeira. 

Although in my account of the climate of Madeira I have con- 
fined myself to its influence on consumption, there can be no doubt 

'Fragments of Voyages and Travels, first series. 



140 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

of its being highly beneficial in several other diseases noticed in 
this work, more especially scrofula and bronchial affections. 

The only part of Madeira where invalids reside during the win- 
ter is Funchal, and its immediate vicinity, which is the warmest 
part of the island. This advantage it owes to its being open only 
towards the south, while it is in a great measure screened from the 
north by the central mass of mountains which rise immediately 
behind it in the form of an amphitheatre. Invalids peculiarly 
sensitive to humidity should live within the limits of the town, on 
account of its greater dryness. The steepness of the island renders 
wheel carriages useless ; invalids must therefore ride, or be carried 
in palanquins or hammocks. There is abundance of horses, sure 
footed, and accustomed to the roads. There are some level spots 
near the town, where invalids may take exercise. 

The soil of Madeira is dry, consisting mostly of the debris of 
volcanic rocks. Provisions of every kind are good and abundant, 
and the water is pure and of excellent quality. 

Invalids intending to pass the winter in Madeira, should leave 
this country in October. The beginning of June is sufficiently 
early to leave the island to return home, as, before the middle or 
end of that month, the weather in England is seldom sufficiently 
warm, or at least steadily so, for a consumptive patient who has 
passed the winter in a mild climate. 

Opportunities of going from this country to Madeira are very 
frequent. Independently of the regular traders to the island, many 
West India vessels, and the monthly packets to the Brazils, touch 
there on the outward voyage. About ten days may be considered 
the average time of making the passage ; frequently it is less, and 
rarely exceeds fifteen days. The opportunities of returning from 
Madeira are, however, by no means so frequent ; as comparatively 
few vessels touch there on their voyage to England. Yet I believe 
that in this respect much inconvenience is not experienced. 1 

CANARIES. 

The Canaries group is nearer the African coast, and a few 
degrees further south than Madeira, from which they are about 
200 miles distant. 

1 The reader who is desirous of obtaining information on the natural his- 
tory, &c. of Madeira, is referred to the writings ol Von Bueh and Gourlay, to 
the very interesting work of Professor Daubeny on Extinct Volcanoes, 
Wilde's Narrative of a Voyage to Madeira and the Mediterranean, 1840, 
and to Dr. Macaulay's paper already referred to. 

A small work, Rambles in Madeira and Portugal, contains much useful in- 
formation, especially in the Appendix, on the Climate &c. of Madeira, written 
by the late Dr. Heineken. There has been recently published a small work, 
The Invalid's Guide to Madeira, by Mr. Cooper, which may be consulted 
with advantage. Mr. Picken's beautiful work, already referred to, also con- 
tains much useful information respecting Madeira, the conveyances to and 
from it, &c. 



ATLANTIC CLIMATES. 141 

Teneriffe is the principal island and the only one of the group pos- 
sessing accommodations for invalids. Above the range of cultiva- 
tion, which is chiefly confined to the coast, the island is covered 
with laurels, arbutuses and pines, whilst the uppermost parts are 
bare and sterile. 

Santa Cruz, the capital, is situated on the southeastern shore of 
the island, and is a clean, well-built town. The country around is 
dry and barren. 

The mean annual temperature of Santa Cruz, is 70°.9 ; while 
that of Funchal, the capital of Madeira, is 64°5. This excess of 
temperature at Santa Cruz, is not equally distributed over the year ; 
the difference between the summers, at the two places, being greater 
than between their winters. While Santa Cruz is 7° warmer than 
Funchal in summer, it is only 5° warmer in winter. The tempera- 
ture is more equable throughout the year at Madeira ; the difference 
between the mean temperature of the summer and winter being 
9°.8. and at Santa Cruz, 12°.3. The heat during the summer is 
considerably higher in the Canaries than at Madeira ; although it 
would appear that in this respect the summer temperature of Oro- 
tava, in the northern part of the island, differs little from that of 
Funchal and its vicinity. 

The climate of Santa Cruz possesses some advantages during 
winter, in point of temperature and dryness, over that of Funchal, 
but there are no accommodations for invalids. There are a few 
places fit for carriage or horse exercise, particularly the terrace 
leading from Santa Cruz to the Lazaret, which is about a mile 
long, and broad enough for a couple of carriages to drive abreast. 
Mosquitoes are found at Santa Cruz during the whole year. 

Orotava is a town on the northwestern side of the island, twenty- 
five miles from Santa Cruz, standing at the foot of the mountain, 
on ground gently sloping towards the sea-shore. It is surrounded 
by vineyards and cornfields. The country immediately behind is 
described as very beautiful, and the roads, though steep, are not so 
precipitous as those of Madeira. Orotava is cooler, but not so dry 
as Santa Cruz. The climate, at an elevation of several hundred 
feet above Orotava, is described as very equable during the whole 
year. As a residence for invalids, Orotava possesses many advan- 
tages over Santa Cruz, in point of accommodations, roads, and 
beauty of country. The invalid residing at Orotava might, by 
changing his residence to a more elevated site, remain throughout 
the summer, without suffering much inconvenience from the heat, 
and he might pass the winter months in the warmer and drier 
climate of Santa Cruz. 

Laguna, the former capital, which is situated at some elevation 
above Santa Cruz is cooler, and might form a good summer resi- 
dence. 

Were the accommodations for strangers at Teneriffe, and the 
means of communication between it and Madeira more frequent, 



142 



CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 



many invalids might benefit greatly by passing the winter partly at 
Funchal and partly at Santa Cruz. 

The following table of the temperature at Orotava, although for 
one year only (1834) is deserving of a place here, in the absence of 
more extensive data. The observations were made with a register 
thermometer, by Mr. Charles Smith, who has resided several years 
on the island. 





Mean 


Mean 


Mean 


Mean 




Mean 


Mean 


Mean 


Mean 


Months. 


Mini 


Maxi- 


Tem- 


Varia- 


Months 


Mini- 


Maxi- 


Tem- 


Varia- 




mun. 


mum. 


perat. 


tion. 




mum. 


mum. 


perat. 


tion. 


Jan. 


55 


68 


61* 


13 


Sept. 


66 


77 


71* 


11 


Feb. 


56 


65 


60* 


9 


Oct. 


65 


77 


71 


12 


March, 


59 


69 


64 


10 


Nov. 


62 


74 


68 


12 


April, 


60 


71 


65* 


11 


Dec. 


60 


71 


65* 


11 


May, 
June, 


63 
65 


75 

77 


69 
71 


12 
12 






















July, 
Aug. 


66 
67 


78 
78 


72 

72* 


12 
11 


Means for 
the Year. 


62 


73J 


67 


11* 



AZORES. 

The Azores, or Western Islands, lie in the midst of the Atlantic 
Ocean, about five degrees further north, and considerably more to 
the westward than Madeira. Of volcanic origin, they rise abruptly 
out of the water, and present numerous mountains, covered to the 
very top with perpetual verdure. The conical mountain, which 
gives name to the island of Pico, and which is about 8000 feet 
high, has its summit often covered with snow during the winter 
and spring. 

St. Michael's is the largest of the Azores, and, with the exception 
of the little island of St. Mary's, the southernmost of the group. It 
is of an irregular oblong form, and extends from' west to east rather 
more than forty-eight miles ; its greatest breadth is eleven and its 
least six miles. The extremities of St. Michael's are mountainous; 
the eastern end the most so; the highest points rise three or four 
thousand feet above the level of the sea; the intermediate part is 
hilly. The soil consists of pumice, volcanic clay, and other decom- 
posed volcanic products, lying upon horizontal strata of basaltic 
lava. 

The chief town of the island is Ponta Delgada, containing up- 
wards of twelve thousand inhabitants. The surrounding country 
is for many miles tolerably level, and the roads fit for carriages. 
Asses, for riding and carrying burdens, may be hired for a small 
sum. Horses and carriages are kept by private individuals. 

Consuls for Britain and America, and many English and Ameri- 
can merchants, reside at Delgada, and there is a Protestant episco- 
pal chapel and chaplain. Furnished lodgings are not to be had, but 
houses may be rented at a moderate sum : there are two boarding 
houses. 



ATLANTIC CLIMATES. 143 

Villa Franca, another town on the southern coast of St. Michael's, 
twelve or fifteen miles to the eastward of Delgada, is more pleasantly- 
situated, being protected behind from the northeast winds by a range 
of mountains. It has a sandy beach, and its neighbourhood is not 
so much obstructed by the high walls of orange gardens as that of 
Delgada. It contains about four thousand inhabitants, but there 
are no English residents. The soil is a light porous pumice, of 
from ten to fifty feet in depth, covering the horizontal strata of lava. 
The heaviest rains are speedily absorbed, so that the roads are left 
dry. The water which niters through this pumice soil is very pure 
and abundant. 

There are no express accommodations for invalids, but houses 
may occasionally be hired. 

The mean in-door temperature of a room without fire, carpet, or 
curtains, in Yilla Franca, during the period from December 1838 to 
April 1839, was 60°.9, with a mean range of 3°.6. The mean out- 
door temperature, during the same time, was 60°.10, and the mean 
daily range 7°.6. The highest point to which the thermometer rose 
in the shade, between eight o'clock in the morning and ten at night, 
was 76°, and the lowest point to which it sank was 51°. Thus, the 
mean temperature during the winter is about 2° colder than Madeira. 
It is to be remarked that the averages out-of-doors were not taken 
with the register thermometer ; they, however, approximate the 
truth, and prove, what is evident to the feelings of the visiter, that 
the temperature is remarkably steady, ranging little from day to 
day, and varying little between day and night. Dr. Bullar remarks, 
"that to his feelings it was always warmer out of doors." 

The monthly average of days on which rain fell in Villa Franca, 
during the period above specified, was ten. This estimate, how- 
ever, affords little direct information as to the humidity of the 
climate. The rain on some days was nothing more than a moun- 
tain scud, of a few minutes duration ; and, at other times, it fell for 
several hours ; but, during the whole five months, there was not a 
day in which many hours were not available for exercise in the 
open air. At the same time, the humidity of the atmosphere is so 
great, that boots grow mouldy in a few days, kid gloves become 
spotted, books feel damp, and clothes, not constantly worn, have a 
musty smell. To prevent these inconveniences, the inhabitants 
frequently expose their clothes to the sunshine. Salt fish soon 
spoils, so that no quantity is ever kept, and no salt is made in the 
islands. 

The prevalent winds were in December northeasterly; in January, 
February, March and April, southerly. The southerly and west- 
erly winds are soft and warm. The northeasterly are cold, but not 
keen. The sirocco is never felt at the Azores. Gales and stormy 
winds blow from the southward and westward, and are not unfre- 
quent. 



144 



CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 











a 










Register Thermometer 


Thermometer in the open air at 


« 


-a 

J5 C 


•e-S 


fcc 




within doors. 


four hours of the day. 




•- £ 


• - c 


c . 










1> _: 
a 

a 


03 ~ 

M =5 
O 




— T3 


Max. 


Min. 


Med. 


Ran. 


A. M. 

8 


P. M. 

1 


P. M. 
6 


P. M. 

10 


Med. 


~ as 

« tD 

•a s 


Dec. 


60 


57 58.5 


4 


55 


63 


52 


58 


57 


5 


17 


12* 


10 


N.E. 


Jan. 


63 


60 61.5 


3 


60 


64 


58 


58 


60 


9 


13 


17* 


10* 


S. E. 


Feb. 


63 


60 ,61.5 


3 


63 


66 


60 


58 


61.25 


8 


10 


25.', 


H 


s.w. 


March 


64 


60 62 


4 


61 


66 


61 


60 


62 


6 


14 


2H 


2 


s.w. 


April 


63 


59 161 

1 


4 


62 


66 


59 


56 


60.25 


10 .. 






S.E. 


Mean 


62. 6 ' 59.2 60.9 


3.6 


60.2 


65 


58 


58 


60.18 


7.6 10.8 


19.25 



The islands of Terceira and Fayal, next in importance to St. 
Michael's, are about 160 miles to the northwest of that island, in 
the centre of the group, together with three others, Pico, St. George, 
and Graciosa. From what he heard, Dr. Bullar thinks Fayal 
damper than St. Michael's. 

The principal town of Fayal is Horta, pleasantly situated on the 
east side of the island, on rising ground sloping down to the margin 
of a fine bay. It contains several thousand inhabitants, many 
Americans and their consul, besides an English consul and physi- 
cian. There is a boarding house, and houses may be rented. The 
country around affords a considerable variety of pleasant walks 
and rides. 

There is constant communication between the Azores and Eng- 
land, during the winter, when the oranges are exported. The 
communications between the different islands is frequent after 
March, but uncertain during winter. 

In all the islands, poultry, eggs, and fish are abundant and cheap. 
In the chief towns, beef and mutton can be procured, as well as 
milk and butter. The bread is light and good. The wines indif- 
ferent, but unadulterated. 

Water at St. Michael's is good and abundant. The soil when 
cultivated, is rich and productive. The whole of the islands abound 
in fine scenery, but there is a deficiency of trees, though not of 
vegetation. 

The climate of this group of small islands, situated in the centre 
of the Northern Atlantic, nearly equidistant from the poles and the 
equator, and surrounded on all sides by a vast extent of ocean, is 
purely oceanic, and affords one of the best examples of a mild, 
humid, equable climate to be met with in the northern hemisphere. 
It is slightly colder and more humid than Madeira, but probably 
even more equable. 

In diseases in which a soft, soothing climate is indicated, that of 
the Azores will prove beneficial ; in gastritic, or inflammatory dys- 
pepsia, and in bronchial irritation, accompanied with little secre- 
tion. On the other hand, in a relaxed state of the system — in those 
morbid conditions of the mucous membranes, attended with copious 



ATLANTIC CLIMATES. 145 

discharges — and in an enfeebled state of the digestive organs, 
(atonic dyspepsia,) it will decidedly disagree. 

There are many cases of a mixed character, where irritation of 
the mucous surfaces co-exists with a relaxed state of system. In 
such the climate may prove beneficial for a time, but as soon as the 
state of irritation is abated, its relaxing effects will prove injurious. 
A removal to a drier and more bracing climate would then be 
desirable and even necessary. 

The most prevalent disease among the natives is gastrodynia, or 
a painful affection of the stomach ; a dull, continuous pain, lasting 
many hours. This is not surprising when the principal food of 
the poor (whose diseases were those which chiefly fell under the 
observation of Dr. Bullar) consists of cabbage and potatoes chopped 
up with a little lard. Painful affections of other parts are next in 
frequency; rheumatic neuralgia, lumbago, sciatica, neuralgic pains 
of the face, neck, and arms, hemicrania and loss of power, partial 
paralysis. Of acute diseases, bronchitis was the most frequent; 
asthma also prevailed ; phthisis is very rare. 1 

Comparing Madeira, the Canaries, and the Azores, it will be 
observed that, although in some circumstances they are alike, they 
are very dissimilar in others. They have the same form and 
geological structure, being all mountainous and of volcanic origin, 
but differ materially in their vegetable productions, and in the cha- 
racter of their climate, both as regards humidity and temperature. 
There is a gradual transition from the humid, soft, equable climate 
of the Azores, of which the mountains are covered to the very 
summit with evergreens, to the arid, rocky soil of Teneriffe where 
the want of rain during the greater part of the year renders much 
of the island dry and sterile. Madeira, situated considerably more 
to the south than the Azores, and more distant from the African 
coast than the Canaries, presents an intermediate climate in com- 
parison with these two groups. Less humid than the Azores, and 
less dry than Teneriffe during the winter, it has the advantage of 
a cooler summer than either. This it owes chiefly to its being 
within the limits of the trade winds during the hot season. 

A change from the Azores to Madeira, and from thence to Tene- 
riffe, would, in many cases, prove more beneficial than a residence 
during the whole winter in any one of these islands. 

• For the above account of the Azores, I am indebted to my friend Dr. 
Bullar, who passed the winter and spring of 1839-40 there ; and who, in 
conjunction with his brother, has just published an interesting work descrip- 
tive of these islands, entitled, "A Winter in the Azores." 



2— c 10 dark 



146 



CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 



WESTERN ATLANTIC. 
BERMUDAS. 

The Bermudas consist of a cluster of small, low islands. The 
largest is only twelve miles long, and about three broad ; and the 
whole extent of the group, from one extremity to the other, is not 
more than twenty miles. The highest point of land in any of the 
islands does not exceed 200 feet above the sea level. They are 
composed chiefly of a coarse, shelly sand-stone of an extremely 
porous quality, and so soft as to be cut easily with the saw and 
adze into the various forms necessary for building, &c. From the 
absorbing nature of the Bermuda rock, the soil, which is naturally 
thin, is extremely arid. There are no springs, the inhabitants being 
almost entirely dependent upon rain water, which is collected on 
the roofs of the houses, and by other artificial means, and preserved 
in stone cisterns, called tanks. The water is generally good, but 
the supply is occasionally deficient in very dry seasons. Although 
the Bermuda islands are low, they are by no means flat, the surface 
being of an undulating and even hilly character. The high grounds 
are mostly covered with cedar trees, which, while they form a pecu- 
liar feature, are the most beautiful ornament of these islands, and, 
at the same time, their most valuable production. But there can be 
no doubt that Bermuda might be made much more productive by 
proper cultivation ; as has indeed been proved during the non- 
intercourse with America. It is, however, in general, supplied 
with provisions from the United States and our North American 
colonies. 



Table of the Range of the Thermometer at St. George's on an Average of 

Five Years: — 



MONTHS. 



January . 
February- 
March . . 
April . . . 
May . . . 
June . . . 
July . . . 
August. . 
September 
October . 
November 
December 



Mean 



THERMOMETER. 


DIURNAL RANGE. 


Max. 


Med. 


Min. 


Greatest. 


Mean. 


Least. 


deg. 


deg. 


deg. 


deg. 


deg. 


deg. 


72 


65| 


55 


8 


4 


If 


71 


64! 


53 


10 


5§ 


1 


72 


65 


54 


n 


4£ 


li 


71 


61| 


56| 


10 


5i 


l* 


75 


70 


57 


11 


6* 


2 


86 


79 


68 


10 


7 


3 


89 


83i 


75 


12 


7i 


2 


89i 


83 


75 


12 


8 


1 


87 


82^ 


74 


9 


6 


4 


86* 


76i 


65 


10 


4| 


1 


82 


76^ 


64 


7 


4 


0i 


76 


69£ 


56 


8 


4i 


o* 


79f 


73i 


63 


n 


5§ 


If 



From the small size and little elevation of the Bermudas, they 
are fully exposed to winds from every quarter, and are under the 






ATLANTIC CLIMATES. 147 

immediate influence of all the changes which occur in the atmo- 
sphere of the surrounding ocean; which, as we have already- 
remarked, is more liable to great and rapid changes of temperature, 
and more subject to storms than the Eastern Atlantic. 

Bermuda may be considered upon the whole a healthy place. 
There are no endemic diseases, although occasionally, during the 
autumn, fevers of a character resembling those which form the 
scourge of the West Indies, prevail with considerable violence ; but 
this is by no means an annual occurrence. Bowel complaints are 
the most common diseases. Consumption is also frequently ob- 
served among the inhabitants; and it appears from the Army- 
Reports that inflammation of the lungs and consumption are very 
prevalent among the troops stationed there. The ratio of mortality 
from consumption being nearly nine per thousand of the strength 
annually, which is more than among the troops in the United King- 
dom, or in any of the Mediterranean stations. 

The cool season, that is, from October till May, is the most 
healthy, and the only part of the year during which this climate is 
at all suited to invalids. One of the principal objections to Ber- 
muda, as a winter residence for pulmonary invalids, is the preva- 
lence of strong winds ; which are such as to justify the epithet ap- 
plied by Shakespeare to these islands, " the still-vexed Bermoothes." 
Of these winds the damp, oppressive southwest is the prevailing ; 
but the most violent and. injurious to delicate invalids during the 
winter and spring, are the northwest winds which are generally 
dry, sharp, and cold. Compared, however, with the climate of the 
coast of America, under the same latitude, Bermuda may be said to 
have no winter. The summer is very hot ; being generally admit- 
ted, I believe, by those who have experienced both climates, to be 
more oppressive than the same season in the West Indies. This 
may be accounted for, partly from the want of the trade winds, and 
partly from the bare, arid nature of the soil, which becomes quite 
parched during the summer. Vegetation almost disappears at this 
season ; the cedar and wild sage alone resisting the heat. Dew is 
occasionally deposited in winter, when a cold night succeeds a hot 
day, but never in the summer. The principal fall of rain is between 
August and October ; there are also very heavy showers in January 
and February, but seldom any during the summer months. 

From what has been stated, a tolerably accurate opinion may be 
formed respecting the general qualities of the climate. It is variable 
and windy during the winter, and hot and oppressive in the sum- 
mer. Compared with Madeira, which lies in the same parallel of 
latitude, the climate will be found much more unequal. The tem- 
perature of the two places during the winter may be much the 
same; but there is a wide difference in that of summer. The cool- 
ness of this season at Madeira forms a striking contrast with the 
oppressive heat of Bermuda. 

With so few advantages in point of climate, the Bermudas are not 
likely to become the resort of invalids from this country. Their 

10* 



148 



CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 



great distance, the infrequency of communication with England, 
and the defective accommodations for strangers, form additional 
objections. Provided, however, that domestic circumstances ren- 
dered Bermuda a convenient residence, invalids might pass the 
winter there safely, and perhaps with benefit. There are many 
beautiful spots in these islands, where, protected from the northerly 
gales by the cedar-clothed hills, the invalid might find sufficient 
space to enjoy exercise in the open air, almost every day during 
the winter. The neighbourhood of the little town of Hamilton, 
situated nearly in the centre of the islands, affords perhaps the most 
favourable situation for such a residence. 

BAHAMAS. 

Were we to consider the latitude only of these islands, they might 
almost be classed with the West Indies, as they are on the very 
limits of the tropics ; but their vicinity to the American continent 
so modifies their climate, as to give it a different character from 
that of the intertropical islands. The Bahama islands form a very 
numerous group, of which about twelve are of considerable size. 
They are all low, and chiefly of coralline formation. They con- 
tain no natural springs, water being procured only by digging deep 
wells ; and, in many places, the water thus obtained is not good. 

The easterly, or trade wind, although the prevailing wind, is 
much less regular here than in the same latitude on the eastern side 
of the Atlantic. Southerly winds, which are hot and oppressive, 
often occur, and are generally accompanied with a heavy deposi- 
tion of dew during the night. The northwest wind frequently 
prevails ; and as this wind blows with very considerable force, it 
produces a rapid fall of temperature, more especially when it im- 
mediately follows a southerly wind. 

The following table shows the monthly range of the thermometer 
at Nassau, on an average of five years, — 1830 to 1834 inclusive : — 



Months. 


Jan. 


Feb. 


Mar. 


Apr. 


May 


Jun. 


July 


Aug. 


Sep.jOct. 


Nov 


Dec. 


Max. . 


77* 


76 


80* 


83 


86* 


89 


92 


90 


89 


83* 


79 


76* 


Med.. 


71 


73 


75 


79 


81* 


84* 


86 


86* 


85 


79 


73 


70 


Min. . 


66 


69* 


69 


75* 


77 


80 


83 


83 


81 


73* 


67 


63* 



Average,— Max. 83*, Med. 78*, Min. 74. 

From May to November the range of the thermometer is from 
75° to 85°, seldom rising above 90°. This increase of temperature 
is generally accompanied by southerly winds or calms, which are 
described as being very oppressive. 

According to these tables, the mean annual temperature is 78%°', 
and the range 28£°; viz., from 63£° to 92°. In the West Indies, 



ATLANTIC CLIMATES. 149 

the former is 80°, the latter 20°. The temperature of the seasons is 
as follows: winter 71°, spring 77°, summer 83°, autumn 80°. At 
Barbadoes, the winter is 76°.7, spring 79°, summer 81°, autumn 80°. 
From this comparison it appears, that while the winter is nearly 6°, 
and the spring 2° colder, the summer is 2°ioarmer than at Barba- 
does : the autumn temperature at both places being the same. The 
explanation of the high temperature of the Bahamas, during the 
two latter seasons, is probably to be found in the frequent occur- 
rence of southerly winds during that period of the year, and in the 
less degree of regularity of the trade winds at these islands than 
within the tropics. In the winter and spring, however, the tempe- 
rature is considerably lower, and this is the period of the year 
which chiefly interests us in our present inquiry. 

At New Providence, the weather, during the cold season, which 
extends from November to May, is generally fine, clear, and dry; 
the thermometer in the shade being generally from 60° to 70°, the 
mid-day heat tempered by a constant breeze, and the evenings cool 
and agreeable. 

The Bahama islands, generally speaking, are not unhealthy ; 
although there is a considerable difference in this respect between 
the different islands. That of New Providence, in which is the 
capital, Nassau, the only town in the colony, is not by any means 
one of the healthiest, on account chiefly of some swampy ground 
which it contains. The small island, called Harbour Island, close 
to Eieuthera, one of the largest of the group, is esteemed particu- 
larly healthy, and forms the chief resort of invalids and convales- 
cents from New Providence. There are several other healthy spots, 
as on the island of Abaco ; but at all these places there is a great 
deficiency of accommodations, and moreover, they are sixty miles 
distant from Nassau, the only place where medical advice is to be 
found. 

The most prevalent diseases, are fevers, chiefly of the intermit- 
tent and remittent character, and bowel complaints ; cholera is not 
uncommon, and occasionally the Bahamas are visited by epidemics 
of yellow fever ; but the two first mentioned diseases are by far the 
most prevalent. 

From the above description, it appears evident that the Bahama 
islands are not well calculated for the generality of invalids. The 
climate is not suited for consumptive patients, on account of the 
rapid changes of temperature, and the prevalence of winds, often of 
a dry, cold character. At the same time persons, for whose cases a 
warm climate is indicated, may pass the winter in the Bahamas 
safely; and residents in the West Indies might derive considerable 
benefit by a change to these islands for a few months during this 
season. The wet and dry seasons occur pretty regularly at the 
same periods of the year, as within the tropics. The same rules 
which are laid down, in the article on The West Indies, respecting 
the arrival and departure of invalids, and the conduct to be observed 



150 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

during their residence, are generally applicable to those visiting the 
Bahamas. 

THE WEST INDIES. 

I consider it necessary to notice the West India Islands, because 
they are occasionally recommended as a winter residence to patients 
labouring under pulmonary and some other chronic diseases ; and 
because their climate, either as regards its physical characters or its 
influence on disease, does not seem to be generally known or under- 
stood by medical n? in this country. 

The mean annr emperature of the W T est India Islands near 
the sea, is ab^< if or 80°; the mean daily range about 6° only; 
and the extreme annual range not more than 20°. The mean tem- 
perature of the sea at considerable depths in the vicinity of these 
islands is 80°; and this is also the temperature of the springs near 
the level of the sea in Jamaica, as noticed by Dr. Hunter. 1 The 
mean temperature of the seasons, according to the European divi- 
sion adopted in this work, is at Barbadoes as follows — winter, 76° 7 ; 
spring, 79°; summer, 81°; autumn, 80°. 

The above applies to the whole of these islands near the level of 
the sea ; the difference in different islands being scarcely worth 
remarking. The mean temperature of Barbadoes, according to 
Hillary, is 79° 3 ; the greatest range in six years being 17 c , viz. 
from 70° to 87°; and Dr. Thomas makes this 18°, viz. from 70° to 
88°. Sir Gilbert Blane once found the thermometer in this island 
at sun-rise, in December, at 69 . 2 Dr. Hunter observed it once 
only at the same degree ; and twice only as high as 91° in Jamaica. 3 
The greatest range which I find noticed by any author at the sea 
level is 22°, viz. from 70° to 92.° Dr. Fergusson says, the mean 
daily range in summer is from 80° to 86°, and in winter from 70° to 
80°. The mean temperature of Grenada, at noon, according to Dr. 
Chisholm, is 84°, and at seven a. m. 78° 5. This gentleman gives 
the following, as the diurnal progression of temperature : — -'The 
thermometer (Fahrenheit's) almost universally exhibits the follow- 
ing movements. At seven a. m. the mercury begins to rise, and 
continues to do so till one p. m., from which time till four p. m. it is 
stationary. It then begins to fall, and continues to do so till ten 
p. m., from which time till seven a. m. it is again stationary. This 
routine of temperature is disturbed only when any remarkable 
change takes place in the atmosphere, such as much rain attended 
with strong wind : the greatest change from this cause I have 
observed is 10°, the least 4°. The thermometer, exposed to the 
direct rays of the sun, has risen in ten minutes to 130°, or 42° above 
its stationary point at one p. m. of that day; 30° may, however, be 
considered the medium difference between the heat in the shade 

1 Observations on Diseases of the Array in Jamaica. 

2 Diseases of Seamen. 3 Op. citat. 



ATLANTIC CLIMATES. 151 

arid in the sun. 1 The medium difference between the heat of the 
atmosphere at one and ten p. m. is 9°." 2 At Jamaica, Dr. Arnold 
always observed the mercury begin to rise about 10 or 15 minutes 
before the sun emerged from the horizon. Its ascent was gradual 
until it reached its maximum, which generally happened between 
two and four p. m. He tried many thermometers for the purpose 
of ascertaining the extreme solar heat, and often observed the 
mercury rise to 130° Fahr. in the month of September. 

The winter, and early part of the spring, are in general remark- 
ably dry, and the weather fine : the wind being more northerly 
than usual. The summer is dry and hot ; and autumn the season 
of the heavy rains ; but there is seen little of that continuous rain 
which occurs in temperate climates. The annual fall of rain is 
probably about 65 inches; 3 but in the quantity of rain which falls 
in the different islands there is a much greater difference than in 
their temperature. In the mountainous islands, generally, the fall 
much exceeds that in the low islands. At Martinique, for example, 
the fall is said to amount to 100 inches ; while at Barbadoes. accord- 
ing to Hillary, it is 58 ; and at Antigua only. 45 inches. The greatest 
fall of rain takes place in October. In November the weather gene- 
rally begins to clear up, the northeasterly winds resume their regu- 
larity; and from the beginning of December till the vernal rains of 
April and May, the weather is dry, settled, and comparatively cool. 

From the rapid manner in which the rain descends within the 
tropics, a large proportion of it is carried off in torrents, and it must 
be remembered that the evaporation is extremely rapid. At Antigua 
it amounted, in 1818, to 28-26 inches, the fall being 65. The 
evaporation in the different seasons was as follows: — Winter, 6*26 ; 
spring, 6-99 ; summer, 809 ; autumn, 7*06; leaving unevaporated — 

1 This great increase of temperature is not produced by the direct power 
of the sun's rays, but is caused chiefly by the concentration and reflection 
of heat from the surface of the earth. If the influence of reflected heat be 
avoided, the difference between the sun and the shade amounts, in the West 
Indies, to a few degrees only. Baron de Humboldt often endeavoured to 
measure the power of the sun between the tropics by two thermometers of 
mercury perfectly equal, one of which remained exposed to the sun, while 
the other was placed in the shade. The difference resulting from the ab- 
sorption of the rays in the ball of the instrument never exceeded 6° 6 Fahr. ; 
sometimes it did not even rise higher than one or two degrees. Mr. Daniell's 
observations go far to show " that the power of solar radiation in the 
atmosphere increases from the equator to the poles, and from below up- 
wards." — Meteorological Essays and Observations. 

The temperature in the shade often rises higher in northern latitudes than 
in the West Indies. It is the duration of heat much more than its intensity, 
as Humboldt justly remarks, which characterises the climate of the tropics. 
And I may add, that it is this unceasing heat which is one of the principal 
causes of the injurious influence of tropical climates on European constitu- 
tions. 

2 Manual of the Climate and Diseases of Tropical Countries, &c, by 
Colin Chisholm, M. D. 

3 Edwards gives from 60 to 65 inches as the average fall throughout the 
whole islands. — History of West Indies, vol. i. p. 12. 



152 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

winter, 5*41 ; spring, 6-22; summer, 6-39; autumn, 19-53. I am 
not aware of any series of hygrometrical observations having been 
made in the West Indies. 1 In the lower islands little dew is depo- 
sited j but in the higher islands, where the range of temperature is 
greater, dew falls in considerable quantity, but still in a very small 
proportion when compared with the opposite continent of America. 
In Jamaica dew is often heavy, and Dr. Melville informs me that it 
is not unfrequent in St. Vincent's. 

The range of atmospheric pressure is remarkably small. At 
Antigua, in 1818, this amounted to half an inch only; and, accord- 
ing to Dr. Chisholm, it does not exceed an inch in any year. 

From the small size of the greater number of these islands, there 
do not occur the regular alternations of land and sea breezes which 
prevail generally in tropical climates, but the same circumstance 
admits of the influence of the easterly, or trade wind, without inter- 
mission. This wind prevails, with great regularity, for nine months 
of the year. During August, September, and October, the trade 
winds are much more irregular, but still the prevailing wind is 
decidedly the east. It is chiefly owing to the full influence of the 
trade wind that the climate of the West India Islands is not only 
tolerable, but infinitely more agreeable than Europeans who have 
never visited them can possibly imagine, when the temperature, as 
indicated by the thermometer, is alone considered. It would appear 
from a register now before me, kept on board one of H. M. ships, 
that the temperature of the air at sea is very nearly the same as on 
the small islands. 2 

We have now to inquire into the influence of this climate on dis- 
ease, and more eper.ially upon Consumption. 

Respecting the prevalence of consumption in the West Indies, 
there exists considerable difference in the statements of those who 
have had ample opportunities of observation. Dr. Musgrave remarks 
of the occurrence of phthisis among the whites, that the subjects of 
it are almost invariably of families in which hereditary predisposi- 
tion has been long established. Amongst the blacks, Dr. Musgrave's 
patients have been chiefly native Africans, disbanded soldiers for 
example, or their immediate offspring ; the creole negro of many 
generations being comparatively free from pulmonary disease of 
every kind. 

On the other hand, it appears from the Army Reports, that nearly 
twice as many cases of consumption originate among our troops in 
the West Indies as at home ; twelve per thousand of the aggregate 
strength of our troops serving in the West Indies being attacked 
annually, while of the Dragoon Guards serving in Great Britain, 

'I am informed by Dr. Musgrave that such are now in progress of being 
made by his colleague Dr. Nicholson. 

2 In this journal, the temperature of the sea-water is often noted in the 
harbours, and at great distances from land, at various depths short of 100 
feet. It varied from 76° to S3° 5. On one occasion the temperature of a 
torrent of rain as it fell, is marked 77°, the temperature of the air being 78°. 



ATLANTIC CLIMATES. 153 

the proportion is only six and a half per thousand. The disease, 
according to the same reports, is even of more frequent occurrence 
among the black than the white troops. 

If we have found cause to condemn Italy as a summer residence 
for consumptive patients, there seems no just reason why we should 
commend the West Indies, even in winter, the temperature of which 
is above the summer temperature of any place in the south of 
Europe. 

More extended experience, and more accurate observation, how- 
ever, than has hitherto been applied to the cases of pulmonary inva- 
lids sent abroad, can alone enable us to speak positively on this 
point. In the mean time, every thing that we know regarding the 
nature of consumption, and the influence of a high temperature on 
it — supported by our practical experience of the effects of the cli- 
mate now under consideration, bear us out in laying it down as a 
general rule, that the climate of the West Indies is an improper one 
for patients with tuberculous disease of the lungs. 

As my own personal experience on the subject is rather limited, 
it may be as well to notice the opinions of those whom a residence 
in the West Indies has afforded ample opportunities of judging. 
Dr. Hunter, speaking of Jamaica, observes: — "Pulmonary con- 
sumptions rarely originate in the island, but those who come from 
England with that complaint already begun, are not benefited by 
the warmth of the climate ; on the contrary, the disease is precipi- 
tated, and proves sooner fatal than it would have done in a more 
temperate air. Of this we had repeated examples among the sol- 
diers, several of whom arrived in the island with beginning con- 
sumptions, and were all quickly carried off by that disease.'" Dr. 
Musgrave and Dr. Arnold agree in this opinion; and Dr. Chisholm 
states, that catarrh, pulmonic inflammation, and phthisis pulmonalis, 
are very frequent in the West Indies; that these diseases are very 
rapid in their progress ; that when phthisis is fully established, there 
is no safety in remaining in the climate. A sea voyage, and tem- 
perate or cool climate, presents then the only, or at least the best, 
chance of life. 2 The opinions of Dr. Fergusson, Sir Alexander Dick- 
son, and Dr. M'Arthur are equally strong on this subject ; and these 
gentlemen, as well as Dr. Chisholm, had peculiar opportunities of 
observing the effects of climate on a very large scale. Dr. Fergusson 
had the direction of the army medical department in these islands 
for several years ; Sir A. Dickson was physician to the fleet in the 
West Indies six years, and Dr. M'Arthur had charge of the Royal 
Naval Hospital at Barbadoes for six years. It was customary in 
our navy at that time to draught seamen, labouring under chronic 
pulmonary diseases, into ships going to the West Indies ; and it 
was constantly observed, that the progress of consumptive cases, to 
a fatal termination, was much more rapid than is generally observed 

1 Op. citat. 2 Op. citat. 



154 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

in more temperate climates. 1 Dr. Fergusson remarked the same 
thing among the military; the disease, to use his own words, 
" resembling, in its progress, an acute rather than a chronic affec- 
tion ;" and Sir A. Dickson's language is equally strong on this 
point. 

It is unnecessary, I presume, to adduce further evidence to prove 
the injurious effects of the West India climate on confirmed con- 
sumption. 

The next point for consideration is the influence of this climate 
on persons predisposed to consumption. Those who have had the 
best opportunities of judging, are in favour of it as a prophylactio 
means. Dr. Fergusson who had extensive opportunities of observ- 
ing the influence of the climate upon our troops, and Dr. Melville 
who has long practised in St. Vincent's, are of this opinion. Dr. 
Musgrave, who has practised twenty-six years in Antigua, says, 
that it has never fallen to his lot to see a single case of consumption 
commencing in a European, whether hereditarily predisposed or 
not, who had arrived in the West Indies in perfect health. Dr. 
Arnold found the climate of Jamaica very favourable to young per- 
sons from fifteen to twenty years of age, hereditarily predisposed to 
consumption. 

Dr. Jackson, of Boston, U. S., whose experience has been some- 
what large, thinks favourably of the West Indian climate in con- 
sumption ; but he does not define the periods of the disease in 
which he finds it most useful. He sends patients chiefly to Cuba ; 
there to remain till the last of April ; then to change to Georgia, or 
South Carolina, and to return to Boston very slowly, so as not to 
reach New England till the end of June. 

Much will depend upon the nature of the constitution — whether 
it is such as is calculated to bear a tropical climate well, or likely 
to sink under the irritating and exhausting effects of heat. When 
the morbid condition of the system, which gives reason to fear the 
approach of phthisis, depends chiefly upon hereditary predisposition, 
and occurs in early life, especially in feeble irritable constitutions, 
the climate of the West Indies will rarely agree. At a more 
advanced period of life, and in constitutions free from much disor- 
der of the nervous system, and of the digestive organs, the climate 
may prove useful. The revolution effected in the distribution of 
the circulating fluids and in the secretions, may have the effect of 
enabling a constitution in which there exists considerable powers, 
to overcome the tuberculous diathesis. 

Independently of the nature of the patient's constitution, other 
circumstances will deserve consideration; for instance, whether the 
invalid can command the accommodations and comforts necessary 

1 So well convinced was Dr. M'Arthur of this, that he thought it his duty 
to communicate the fact officially to the head of the Naval Medical depart- 
ment; and I am informed by Sir William Burnett, Inspector General of the 
Navy, that the practice of sending consumptive sailors to this and other hot 
climates has long since been discontinued. 



ATLANTIC CLIMATES. 155 

upon a voyage, and during his residence in the West Indies ; 
whether he may have the power of selecting a proper situation, and 
of quitting the country on the approach of the summer heat, &c. 

It is a remarkable fact, confirmed to me by Drs. Arnold and 
Musgrave, that persons obviously predisposed to consumption are 
rarely attacked by the indigenous fever. 

The cases of Pulmonary Consumption, therefore, in which the 
climate of the West Indies promises advantage are very few, and 
their character scarcely ascertained ; while those in which it pro- 
duces mischief are numerous, and generally well marked. Of per- 
sons predisposed to the disease, a certain proportion are likely to be 
benefited by the climate, — but the nature of the constitution should 
be well considered before it is recommended even as a prophylactic. 

The affections of the chest most likely to derive benefit from a 
residence in the West Indies are chronic diseases of the bronchial 
membrane, occurring in persons otherwise of a tolerably sound con- 
stitution. " Persons," says Dr. M'Arthur, " labouring under chronic 
cough, about the middle period of life, and whose health is other- 
wise good, derive much benefit from the climate.'' In asthma, 
however, the same gentleman has generally observed the climate 
injurious. In both these statements, Dr. Melville's experience leads 
him to coincide. Dr. Arnold, however, did not find it so in Jamaica, 
where he has seen many cases of this disease benefited by the cli- 
mate. I have not myself had sufficient experience to enable me to 
form an opinion on the subject; but I can have no doubt that the 
cases in which the climate will prove most useful, are those in 
which the disease is chiefly confined to the bronchial membrane, 
and in which the digestive organs are in a sound state. 

In stomach complaints the West Indies are very generally unfa- 
vourable. The extreme activity of the cutaneous circulation, ex- 
cited and kept up by the great heat of the atmosphere, although it 
may diminish internal congestion, induces, I am inclined to think, 
after a time, an irritable condition of the mucous membrane of the 
stomach and bowels, combined with a state of relaxation, which 
greatly predisposes to dyspepsia, dysentery, and other disorders of 
the abdominalviscera, and to gastric fevers: — diseases which make 
up almost the sum of mortality among Europeans in the West 
Indies. At the same time I do not mean to deny that in certain 
cases of dyspepsia, of long standing, a residence in this climate may 
prove beneficial ; just as we find other great changes, of various 
and even opposite kinds, in the condition of the individual, effect a 
cure in this and other diseases, of which, in our limited knowledge 
of the animal economy, we are unable to render a satisfactory 
explanation. 

Chronic Rheumatism. — The marked benefit derived in this dis- 
ease from a mild climate, probably led to the belief that the West 
India and other tropical climates would prove still more beneficial. 
Experience, however, has not justified the expectation. While 
some cases of the disease are benefited by the climate of the West 



156 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

Indies, others are, on the contrary, aggravated by it. When the 
rheumatic affection is symptomatic of, or accompanied with, an 
irritable state of the digestive organs, or a feeble relaxed state of 
the system, the climate will disagree. :i Chronic rheumatism,"' says 
Dr. M-Arthur, " when the general health is unimpaired, is much 
relieved, but when the health is deteriorated, the powers of the 
digestive organs much weakened, or the disease attended with pro- 
fuse perspirations, nothing but a return to a cooler climate can save 
the patient." In my own opinion, the climate is too hot for the 
generality of rheumatic patients. Our soldiers and sailors are fre- 
quently invalided from the West Indies on account of rheumatism. 
Dr. Grainger says that this disease, in the chronic form, is more 
prevalent there than in this country, especially sciatica; and Dr. 
Wright adds, that acute rheumatism is frequent in the West Indies. 1 
Hereditary gout, Dr. Musgrave says, is often as severe in the West 
Indies as in England. On the other hand, Dr. Arnold states that 
gout and rheumatism, according to his experience, are of rare 
occurrence in Jamaica, and he has known many cases of these dis- 
eases benefited by a temporary residence in the West Indies ; but 
in Jamaica it is to be remarked, rheumatic affections are much less 
prevalent among our troops than in the Windward and Leeward 
Command, or in Great Britain. — Army Reports. 

Calculous disorders are rare in the West Indies. Dr. Musgrave 
has met with stone in the bladder once only, but he has seen several 
cases in which renal calculi, after the usual symptoms, were passed 
by the urethra. Dr. Arnold, during an extensive practice in Jamaica 
of twenty years, met with two cases only of calculus. Diseases of 
the heart and large vessels are also rare, and the osseous deposits, 
which are so generally found in the coats of the larger arteries in 
persons who die at an advanced age in cold climates, are said to be 
rarely met with in those who die at a similar age in the West 
Indies. 

The climate generally proves serviceable in scrofula, which is a 
rare disease in the West Indies. Dr. Fergusson, in particular, 
speaks in strong terms of the beneficial effects which he has ob- 
served the climate produce in scrofulous diseases; Dr. Melville 
coincides in this; but Dr. Arnold limits the utility of the climate to 
incipient states only. 

In the higher districts of the interior of Jamaica the children are 
uncommonly fine : and the children of Europeans and Creoles 
continue to thrive well till they attain the age of eight or nine 
years, after which they generally begin to droop. At this age, 
therefore, children should be sent to a more temperate climate. Dr. 
Arnold remarks that the diseases of childhood, measles, scarlatina, 
&c. are generally mild. 

To persons of weak irritable constitutions, or with irritable 

1 Essay on the More Common West India Diseases, by James Grain- 
ger, M. D 



ATLANTIC CLIMATES. 157 

bowels, or deranged digestive organs generally, or with an irritable 
skin, or subject to cutaneous eruptions of an irritable character, or 
too copious perspirations, the West Indies will prove injurious. 
Persons subject to severe headaches, or who have any hereditary 
disposition to cerebral disease, or to insanity, and fair plethoric 
people generally, should also avoid the tropics. 

Having given an account of the climate of the West Indies, in 
general, I shall now notice the islands which are considered the 
most healthy, and where invalids may obtain all the advantages 
which the climate affords. These are Jamaica, Barbadoes, St. Vin- 
cent's, Antigua, and St. Kitt's. 

In many other islands there are, perhaps, to be found situations 
equal in point of salubrity to any of these ; and there are among 
the small islands more than one entirely free from all endemic 
sources of disease. 1 Yet the islands just named possess advantages, 
which, upon the whole, render them preferable to all the others as 
the resort of invalids. Of these, St. Vincent's and St. Kitt's are 
mountainous ; Barbadoes and Antigua are low islands. As St. 
Vincent's lies in the vicinity of Barbadoes and Antigua, near St. 
Kitt's, the invalid may without much inconvenience or difficulty 
change his residence, and in some degree his climate, by passing to 
the higher situations in the neighbouring mountain island, and the 
reverse. This, as we shall have occasion to show, is a matter of 
considerable importance. 

Jamaica. — On account of the size of the island, and the height of 
its central ridge of mountains, 2 the climate of Jamaica differs in 
some respects from that of the other islands. It has a greater range 
of temperature, and, therefore, a greater variety of climate. There 
is a considerable difference between the lower and higher parts, 
and between the north and south sides of the island. It has also 
the advantage of a sea and land breeze, which the smaller islands 
have not. Dews are abundant. More rain falls on the north than 
on the south side of the island. On an average of five years it 
rained 116 days ; the fall is 50 inches. The difference of tempera- 
ture between the north aiad south sides of the island amounts to 5° 
during the whole year, and in the first three months of the year to 
from 8° to 10°. 

In the mountainous districts of St. Andrew and Port Royal, there 

1 Of this kind is one of the small islands called the Saintes, situated 
between Guadaloupe and Dominica, which possesses an excellent harbour. 
But there are here no accommodations for invalids. 

2 The altitude of the highest of the three peaks of the Blue Mountains is 
8,500 feet above the level of the sea. 

The temperature averages, from January to April, in the early morning 
55°, in the afternoon 70°; 

From April to June 60°, in the afternoon 75° 
„ June to Sept. 65°, ditto, 80° 

,, Sept. to Dec. 65°, ditto, 75° 

This may be considered the mean temperature of a series of years. 



158 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

are residences and settlements, three or four thousand feet above 
the level of the sea, where the air is temperate and salubrious all the 
year round, but more particularly from the month of January to the 
end of May. Probably the most healthy district is the mountainous 
part of the parish of St. Ann, which is nearly in the centre of the 
island. 

The mean temperature of the year at this place is 76°. It is 
generally speaking a dry district ; there are no morasses or jungle, 
and the carriage roads are excellent. 

Convalescents from other parts of the island often derive consi- 
derable benefit from a residence of a few weeks only in this region. 
It is also a safe temporary retreat for consumptive as well as other 
invalids. 

Lncea also, has a high reputation for salubrity among the inha- 
bitants, and is often resorted to by convalescents ; the climate is 
cool and pleasant except during the months of July, August and 
September. 

Barbadoes is one of the healthiest islands; it is almost entirely 
free from marshy grounds ; and, from being cultivated throughout, 
and comparatively level, it affords more opportunities of exercise 
than many of the others. The capital, Bridgetown, although more 
healthy than most of the sea-ports in this country, is the most 
unhealthy spot in the island. It should, therefore, be avoided as a 
residence by the invalid. Speightstown, on the northwestern ex- 
tremity of the island, is the best residence in the form a town ; 
but if accommodations could be found, the higher grounds in 
the interior of the island possess many advantages. The part 
of the island called Scotland is from 600 to 800 feet above the 
level of the sea, and is constantly perflated by the trade wind. 
It is therefore cooler than the lower parts of the island, without 
being subject to the great and sudden alternations of temperature, 
which are experienced in the more elevated situations of the 
mountainous islands. This district is also remarkably healthy. 
So high an opinion did Dr. Fergusson form of the salubrity of this 
spot, he informs me, that after a careful topographical survey of the 
whole Caribbean Archipelago, with which he was occupied three 
years, he recommended it officially to government as the best situa- 
tion for establishing a general convalescent depot, for the debili- 
tated invalid troops of all the other islands, instead of sending them 
to Europe as was the usual custom. 

Notwithstanding the uniformity of temperature which prevails 
among these islands, the effect of a change from one to another is 
often very remarkable in improving the health. This has been 
observed frequently, on a large scale, among our troops stationed in 
the West Indies ; and, indeed, I believe, one of the most powerful 
means of diminishing the sickness among our troops in that climate, 
would be to remove them frequently from one healthy island to an- 
other ; or still better, send them to sea for a few weeks. 

St. Vincent's lies directly to the westward of Barbadoes, from 



ATLANTIC CLIMATES. 159 

which it is distant only a few hours sail. Its capital, Kingston, is 
almost peculiar, Dr. Fergusson remarks, in being built in a healthy 
site on the shores of a fine bay. A cool situation may be found by 
ascending the mountains which compose the greater bulk of this 
beautiful and romantic island. But here the difficulty of finding 
accommodations will be still greater than in the higher parts of 
Barbadoes. 

Antigua, although one of the low islands, is, in many parts, con- 
siderably more elevated than Barbadoes. There are some unhealthy 
spots in this island, but the greater part of it is healthy; and many 
positions on its rounded hills favourable to health may be found. 
The fall of rain is forty-five inches. Dryness of atmosphere cha- 
racterises the climate both of Barbadoes and Antigua. Antigua 
bears the same relation, in point of elevation, to St. Kitt's, that 
Barbadoes does to St. Vincent's. The climate of Antigua, accord- 
ing to the Army Reports, may be considered as more favourable 
both to white and black troops than most of the others in the 
command. 

St. Kitt's, (or St. Christopher's) is one of the most beautiful 
islands in the West Indies, rivaling Barbadoes in many respects, 
and excelling it in others, as a residence for invalids. Indeed, 
among my medical friends, who have visited the Caribbean Islands, 
I think the greater number give this island the preference over all 
the others, certainly over all the high islands. The greater part of 
St. Kitt's is healthy ; and from its mountainous character, it affords 
the invalid an opportunity of seeking a cooler climate ; but here, 
unfortunately, the means of accommodation are greatly limited ; 
and we speak rather of what it might afford, than what it really 
possesses. A situation of this kind, called Spooner's Level, is 
described by Dr. Fergusson, in a written communication to me, as 
embosomed in the great volcanic central ridge, which divides the 
island longitudinally ; and at an elevation of 1400 feet above the 
level of the sea, in a climate, and amid scenery truly beautiful, 
affording the most delightful atmosphere which he ever breathed. 
St. Kitt's has also the advantage of excellent roads. Considering 
all things, St. Kitt's, as a high, and Barbadoes as a low island, 
appear to deserve the preference over all the other small islands. 
But a more advantageous and better plan for the invalid, than 
residing in any one island, would be to cruize among, or make 
short visits to the different islands. St. Kitt's, from its situation 
among a group of islands, is well situated for the head quarters of 
an invalid, having such a plan in view. 

The little island of Nevis, in the immediate vicinity of St. Kitt's, 
and similar to it in its physical characters, deserves perhaps to be 
mentioned. It is considered very healthy. 

By referring to what has been stated respecting the seasons in 
the West Indies, the proper time for the residence of the invalid in 
that country will be found to be from the beginning of December 
to the end of April. This period is alone suited to invalids who 



160 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

visit the West Indies for the recovery of their health. It is the 
coolest and most healthy part of the year, — the epithet healthy 
being applied to it, in contradistinction to the autumn, which is 
termed the unhealthy season, from being the time during which 
the endemic diseases, which are the scourge of the West Indies, 
prevail with the greatest force. By leaving England in the end of 
October, or beginning of November, the invalid would reach the 
West Indies at the proper season ; and he should contrive, if pos- 
sible, not to return to this country until the end of June. 

Before concluding the subject of the West Indies, it may be well 
to add a few remarks on the management of the invalid during his 
voyage to, and residence in these islands, as this is a subject on 
which he is likely to receive very contradictory, and often very 
erroneous counsel. 

On approaching the tropics, when about the 25th or 24th degree 
of latitude, where the temperature ranges from 70° to 80°, a degree 
of general excitement is very often experienced, and a disposition 
to catarrhal affections which demands particular attention on the 
part of the invalid labouring under any chronic pulmonary disease. 

The proper means to prevent any injurious effects from the in- 
crease of temperature, is to live somewhat more abstemiously than 
usual, and upon less exciting food. The quantity of wine generally 
drunk should be diminished, or it may be advisable to abstain from 
wine altogether. Long exposure to the direct rays of the sun, 
should also be avoided. Attention to these circumstances, with the 
use of a little cooling laxative medicine, will generally be all that is 
necessary on arriving in the West Indies. For some time after- 
wards a continuance of the same simple, unexciting regimen, 
should be persevered in, in order that the system may become 
habituated to the exciting influence of a high temperature, and 
until the increased cutaneous secretion, which appears to be one of 
the principal means employed by nature to enable the living body 
to bear the heat of a tropical climate without injury, is fully esta- 
blished. Whether approaching or residing in the West Indies, this, 
says Dr. Arnold, is the grand secret for the preservation of health, 
and to the neglect of it, and the adoption of an opposite mode of 
living, is to be attributed in a great degree the sickness and mor- 
tality among the European residents in these islands, and indeed in 
all tropical climates. Exercise in the middle of the day, and expo- 
sure to currents of air while in a state of perspiration, should be 
carefully avoided. From these two causes, and an over-exciting 
diet, are produced a great proportion of the diseases which prove so 
fatal to Europeans in the West Indies. With respect to clothing, it 
is now universally admitted, I believe, by those who have resided 
in a tropical climate, that flannel is the safest and best covering 
next the skin. Although the general temperature of the winter is 
very high, yet dry, cool winds, frequently occur, and give rise to 
catarrhal and other inflammatory affections of the lungs. In March 
and April, when the greatest difference exists between the tempera- 



ATLANTIC CLIMATES. 161 

ture of the day and night, Dr. Hunter found catarrhs frequent in 
Jamaica. Dr. Chisholm states, that in those parts of the islands 
especially which are exposed to the sharp northerly winds of the 
spring, called norths, the inhabitants are annually afflicted at that 
season with pulmonary and hepatic inflammation. He adds further, 
that it is a grievous error to believe that catarrhal complaints are 
rare in the torrid zone ; and, in addition to his own experience, he 
cites that of M. Desportes, an intelligent French physician, who 
practised many years in the island of St. Domingo, who observes 
that " les habitans des pays chauds sont encore plus sujets aux 
catarrhes que ceux des temperes." A medical friend, who long 
enjoyed an extensive practice in Barbadoes, and to whom I am 
indebted for some useful information on the subject of this article, 
informs me, that epidemic catarrhs are frequent in that island, and 
often prove fatal to the black inhabitants ; and Hillary also describes 
catarrhal fevers as of frequent occurrence in Barbadoes in his time, 
and often epidemic, spreading over the whole island, and sparing 
neither whites nor blacks. 

It must not be believed from this, that Barbadoes is more subject 
to catarrhal affections than the other islands; they have only been 
better described. Dr. Grainger, who practised in St. Kitt's, observes, 
that coughs are common in the West Indies, from the latter end of 
October to the latter end of February. 1 Dr. Arnold, in his work, 
has also remarked the occurrence of bronchial affections in Jamaica, 
but describes them as mild compared to the same diseases in Eng- 
land, and as being curable by very mild treatment. 2 Dr. Musgrave 
agrees in this, and says that epidemic influenza sometimes prevails, 
but is a mild disease, easily yielding to the simplest remedies. 

There is one circumstance in the character of tropical diseases, 
which the European visiting these colonies should be fully im- 
pressed with, and that is, their violence and very rapid progress. 
This is more especially the case with fevers and inflammations; in 
such cases, the remedies require to be applied early, and with an 
energy proportioned to the violence of the disease. On this account 
it is advisable to call in medical advice the moment disease makes 
its attack. 

From what has been said, it is manifest, that he who visits the 
West Indies, more especially with a view to the restoration of his 
health, requires to conduct himself with great circumspection. 3 
Nor must his care cease with leaving these islands. On returning 
to this country, he has to guard against the effects of the change of 

1 Op. citat. 

2 A Practical Treatise on the Bilious Remittent Fever, &c. To which is 
added, Medical Topography of the Different Military Stations in Jamaica. 
London, 1840. 

3 For more detailed information respecting tropical diseases and hygiene, 
the reader is referred to Dr. James Johnson's comprehensive and valuable 
work, The Influence of Tropical Climates on European Constitutions. 
Fifth Edition, London, 1836. 

2— d 11 dark 



162 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

climate, and must provide for it by suitable clothing. In this respect 
he should anticipate the change of climate; and avoid exposing 
himself long, on deck, to damp, cold winds. The complaints most 
likely to attack persons returning from a hot to a cold or temperate 
climate are diarrhoea, catarrh, and rheumatism, or a relapse of any 
disease to which the person had been subject. All these may be 
prevented by warm clothing, attention to diet, and avoiding unne- 
cessary exposure in cold and damp weather. 



APPENDIX 



I. 

CLIMATES OF THE SOUTHERN HEMISPHERE. 



I have limited my observations in the foregoing pages to the 
climates of the Northern Hemisphere ; but the Southern Hemisphere 
also affords climates in every way congenial to the European con- 
stitution, and calculated to exert on the health the same beneficial 
influence as the best northern climates. The Cape of Good Hope, 
Australia, and New Zealand, present themselves for choice among 
the British possessions, and offer peculiar advantages to those whose 
inclination or circumstances lead them to seek a permanent settle- 
ment in the climate which is most likely to suit their constitution. 

Although we have not any very extensive data by which to esti- 
mate the precise characters of the climates of these different regions, 
we yet have the experience of a considerable period, during which, 
with the exception of New Zealand, the countries above named 
have been inhabited by the English ; and even respecting New Zea- 
land we possess information which enables us to form a tolerably 
accurate opinion of the climate, and its influence on the health of 
natives of this country, and to compare it with the other places 
referred to in the Southern Ocean. 

From the situation south of the Equator of the countries under 
consideration, their seasons are the reverse of ours. Thus August, 
September, and October constitute the Spring months ; November, 
December, and January, Summer ; February, March, and April, 
Autumn.; and May, June, and July, Winter, 

CAPE OF GOOD HOPE. 

For the few remarks to be made on the climate of the Cape I am 
indebted chiefly to the j\.rmy Returns, so often referred to. 

11* 



164 



CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 



The range of the thermometer at Cape Town, taken on the 
average of seven years (1827 — 33), was as under : — 



Months. 


Jan. 


Feb. 


Mar.JApr. 


May 


Jun. 


July 


Aug. 


Sep.'Oct. 


Novl Dec. 


Max. . . 


86 


84$ 


82 


78 


73 


67$ 


65 ^ 


67 


68 


72$ 


77 


80 


Med. . . 


78 


76$ 


75 


71 


66$ 


61 


59$ 


61 


62$ 


65$ 


70 


74 


Min. . . 


72£ 


70 


68$ 


65$ 


61 


57 


56 


56 


57 


60 


63 


69 



A table such as this, however, which only indicates the range of 
the thermometer in the shade, cannot convey any adequate idea of 
the intense heat occasioned by the reflection of the sun's rays from 
the adjacent mountains. 

The character of the atmosphere is that of dryness ; but the 
scarcity of rain and moisture, which renders a great part of the 
interior in certain seasons a barren desert, is much less experienced 
in the Cape district. The average number of days on which rain 
fell during a series of years, was seventy-five, and the quantity 
which fell averaged 41 inches, annually. 

The most common winds at Cape Town are from the southeast 
and northwest. The former is the prevailing wind of the summer 
season, and from its blowing over the sandy flats between the town 
and Simon's Bay, is usually sultry, relaxing, and debilitating ; the 
latter, the prevailing wind of the winter months, being a sea-breeze, 
is cold, chilly, and often accompanied by heavy falls of rain and 
violent gales. 

Southwesterly winds prevail during spring and autumn, and 
from passing over the wide expanse of the Southern Ocean are 
generally surcharged with moisture, which wraps the summits of 
the mountains over Cape Town in dense fogs. As the upper stratum 
of the air becomes cooled, the fogs rapidly descend in tempestuous 
blasts, causing an immediate reduction of temperature, with an 
equally sudden transition from an extremely dry to a damp raw 
state of atmosphere. These winds are often accompanied with 
rain, which, however, is never so heavy as that brought by the 
winter wind, being only what is commonly known by the name of 
a " Scotch mist !" 

From the Army Reports it appears, that the climate of the Cape 
district is at least as favourable to the health as that of Britain. 
Fevers of the intermittent and remittent type are extremely rare 
among the troops, and unknown among the inhabitants. The 
troops are less subject to diseases of the lungs at Cape Town than 
in our other colonies ; and there is a smaller proportion of deaths 
from consumption than has been observed on any foreign station, 
except the East Indies. Rheumatism, which is more frequent 
among the civil inhabitants even than among the troops, prevails 
among the latter to a greater extent than at home, or in the other 
colonies. 



SOUTHERN HEMISPHERE. 



165 



The Eastern Province, including the new settlement of Albany, 
although subject to sudden variations of temperature, is in an emi- 
nent degree favourable to the European constitution. From the 
Army Reports as well as from what is known in regard to the mor- 
tality among the civil population, there can be no doubt that this 
portion of the colony is more favourable to health than the United 
Kingdom. The low ratio of sickness and mortality among the 
troops has been mainly attributable to the extreme rarity of diseases 
of the lungs. Pneumonia and consumption in particular are still 
less frequent than at Cape Town. Fevers also are even more rare 
and less fatal, but rheumatic diseases are exceedingly common. 1 

The places chiefly resorted to by invalids from India and Eng- 
land at the Cape of Good Hope, are Rondebosch, about five, and 
Wynberg about eight miles from Cape Town. At both places 
there are many comfortable commodious houses to be hired, and 
three public boarding-houses. There is a church at each place, 
and good English society. Living is very moderate. 

These places are much cooler than Cape Town, chiefly owing to 
their being open to the southeast wind, which blows nearly the 
whole summer. 

There are shady walks and rides, but the roads are very dusty. 

The following will give an idea of the climate to be obtained 
during the summer months. The observations were taken in a 
sitting-room at Rondebosch, door and windows generally open, not 
much exposed to the sun, by the late Rev. Mr. Ash — 





Aver. Range of 
24 hours. 


Aver. tem. 
at 2 o'clock. 


Extr 
min. 


ernes, 
max. 


Rain fell on 


From Dec. 17th to? 
Dec. 31st. . . 5 

January 

February 

March . 


65£ to 69 


68 


61 


77 


2 days 


67i to 70| 


69i 


65 


76 


7 days 


67f t0 71 t 


69f 


65 


78^ 


7 days 


65£ to 69i 


6Vo 


61 


74 


7 days 



AUSTRALIAN CLIMATE. 



In a tract of country of such extent as Australia, various climates 
must necessarily be found. The settled districts are between the 
30th and 43d degrees of south latitude, and possess generally a 



' In regard to the frequency of rheumatism at the Cape, Dr. Smith says, 
in a letter to me, "that he is much disposed to attribute it to the injudicious 
practice which prevails, among persons of all classes, of seeking comfort in 
currents of cold air while in a state of perspiration, and often while much 
of their clothing is thrown off." It is to be remarked, that in New South 
Wales, which is similar to the Cape in point of climate, rheumatism is also 
prevalent and severe. 



166 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

climate, which, though it may be characterised as temperate, and 
such as is congenial to the European constitution, presents several 
peculiarities. 

New South Wales. — We are better acquainted with the climate 
of New South Wales than of any other part of Australia. 

One peculiarity of the climate, is its liability to occasional great 
droughts, for instance five months without rain, as in 1826. An- 
other evil of the climate is the occasional prevalence of dry sultry 
winds. 

"The most singular phenomenon," says Dr. Lang, "in the 
meteorology of New South Wales, is the occasional prevalence of 
hot winds from the northwestward. These winds occur on an 
average four times every summer, and blow from twenty-four to 
thirty-six hours each time, the atmosphere all the while feeling like 
a current of heated air from a furnace, and the thermometer gene- 
rally standing at from 90° to 100° of Fahrenheit. It has even stood 
as high on one occasion, within my own experience, as 112£°. 
This hot wind is usually succeeded suddenly by a wind from the 
south, which causes the mercury in the thermometer to descend 
with great velocity." 1 

The following table for Sidney affords a pretty good idea of the 
climate as regards temperature : — 

Means of the Thermometer, from May, 1821, to April, 1822, 
according to Major Goulburn ; and from May, 1822, to May, 
1823, according to Sir Thos. Brisbane. 

Goulburn. Brisbane. Mean. 

January 72.14 72.86 7*.50 

February 73.04 68.36 70.70 

March 71.80 59.90 65.85 

April 67.46 59.00 63.23 

May 61.16 59.90 60.53 

June 57.20 53.42 55.31 

July 55.04 51.44 53.24 

August 54.86 56.48 55.67 

September 60.98 61.88 61.43 

October 64.76 68.00 66.38 

November 65.84 71.96 68.90 

December 72.14 73.94 73.04 

Summer 72.50 71.78 72.14 

Autumn 66.20 59.54 62.87 

Winter 61.34 52.78 57.56 

Spring 63.86 67.28 65.57 

Annual 64.40 63.14 63.68 

The observations of Goulbourn were made at three different 
hours, viz. six o'clock a. m., noon, and eight, p. m. 

1 Historical and Statistical Account of New South Wales. London, 1S37. 



SOUTHERN HEMISPHERE. 



167 



Yearly mean for 6 a. m 63.14 

do. do. Noon 65.48 

do. do. 8 p. m 64.94 

This shows how small the daily range of temperature is. 

Fall of Rain. — The following was the number of days, accord- 
ing to Goulburn, in each month on which rain fell during the year, 
from May, 1821, to April, 1822:— 

May — , June 9, July 8, August 10, September 9, October 6, Novem- 
ber 8, December 7, January 7, February 14, March 19, April 12. 

The number of rainy days for May has been omitted ; but if 
eight be allowed, the number for the whole year will be 107. In 
1813-14, a year of drought, the number of days on which rain fell 
was only 61. 

From the general dryness of the air, the heat in New South 
Wales is much less oppressive at equal degrees of temperature than 
in England. 

In the winter the cold is but little felt in the lower parts of the 
colony bordering on the sea ; but in the interior the frosts between 
night and morning are strong enough to leave upon the shallow 
pools ice of the thickness of a shilling. 

South Australia. — The climate of South Australia is described 
as pleasant, except during the summer months, when the heat is 
disagreeably great. " The only objection," says Mr. James, " I 
have to the climate, is the extreme changes of temperature, gene- 
rally three times a-day, increasing greatly the difficulty of escaping 
colds. At present, for example, the thermometer in the morning 
may be about 66° ; 96° or 98° at mid-day ; and 66°, or even lower, 
again by night." 

From the general dryness of the air, however, the heat is much 
less oppressive than might be expected from the height of the 
thermometer. 

Swan River. — The climate of Western Australia is much the 
same as that of New South Wales, only more moist, and not so 
liable to droughts. 

Van Diemen's Land. — The climate of Yan Diemen's Land is 
free from the droughts of the Australian Continent, and though 
cooler is more changeable. 

The following is the result of Sir Thos. Brisbane's thermometri- 
cal observations made at Hobart Town during the year 1822 : — 



January 
February 
March . 
April 
May . . 
June 
July . . 
August . 
September 



62.96 
63.14 
55.40 
53.60 
45.68 
41.00 
40.10 
45.50 
47.12 



October 

November 

December 

Spring . 
Summer 
Autumn 
Winter 
Year . 



53.96 
57.56 
62.96 

52.88 
62.96 
51.44 
42.26 
52.34 



168 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

There is little or no snow ; the climate is dry ; the breezes gene- 
rally become gales, and when from the south, which is almost daily, 
they are felt to be very cold. From October 16 to February 23 
(the summer in Van Diemen's Land), the weather was as follows : 

Rainy 42 

Strong winds 24 

Fine and pleasant 28 

Very fine 29 

Wind too hot 7 

Hottest day, 25th January, thermometer in the shade, 99£°; coldest 

day, 16th of October, 56°. 1 

The climate of Australia is, according to all accounts, remark- 
ably healthy. Fevers are almost unknown, and the same may be 
said of hooping-cough, croup, &c. 

Europeans, enervated by a residence in India, become very much 
invigorated and improved in health by a short stay in Australia. 

Dysentery is the most prevalent and most fatal disease to which 
the colonists are subject. Few new comers, it is stated, escape an 
attack ; and of the convicts who die in the civil hospitals, it is the 
cause of death in one half. 

By a statistical report of the cases treated in the civil hospital at 
Sydney, in the year 1835, it appears that the most prevalent diseases 
were dysentery, rheumatism, ophthalmia, and catarrh; the number 
of cases of these four diseases being together 1937, out of a total 
number of 2654. 

Catarrh prevails as an epidemic from time to time. 

Owing to some deficiency in the returns, the Military Statistical 
Report on the Diseases of Australia, has not yet been completed, but 
in the introduction to the volume last presented to parliament we 
find it stated, that "the extreme salubrity of the climate may be 
estimated from the circumstance that on the average of twenty 
years, from 1817 to 1836 inclusive, the mortality did not exceed 
fourteen per thousand of the force annually, whereof more than a 
fifth part arose from violent or accidental deaths, principally attri- 
butable to the nature of the duties on which the troops were 
employed. Thus the mortality from disease alone could have 
amounted to little more than one per cent, annually, being lower 
than in any other colony, except the Eastern Provinces of the 
Cape of Good Hope, to which the climate of Australia is in many 
respects similar." 

In the Transactions of the Provincial Medical and Surgical Asso- 
ciation, a summary of the diseases treated in the Colonial Hospital at 
Hobart Town, for a period of eleven years, from 1821 to 1831 

1 Journal of a Gentleman visiting Van Diemen's Land to recruit his heahh 
after a lengthened residence in India, quoted in Swainson's Observations on 
the Climate of New Zealand, a small work recently published, giving a 
condensed view of all the information we possess on the subject. 



SOUTHERN HEMISPHERE. 



169 



inclusive, is given by Mr. Scott. 1 As this return seems to have 
been prepared with considerable care, it is possible, from the pro- 
portion which the diseases therein enumerated bear to the general 
mass, compared with the proportion which the same diseases bear 
to the whole number under treatment in the military hospitals at 
other foreign stations, to form an approximation to an estimate of 
the influence of the climate of Van Diemen's Land. In this com- 
parison we shall confine ourselves principally to diseases of the 
lungs, which seem to be of rather unfrequent occurrence in that 
part of Australia. 



irt Town . . . . < 



Hobai 

Cape of Good Hope 

Gibraltar 

Malta 

Ionian Islam 



ids . . . j 



Out of ) 
30,102. $ 

Proportion 
Out of > 
25,506. $ 

Proportion 
Out of > 
58,227. \ 

Proportion- 
Out of > 
46,639. S 

Proportion 
Out of 
84,438. 

Proportion 



Pneumonia 

and Hernoptisis 
Pleuritis. 



516 
1 in 58 

673 
1 in 33 

2543 
lin23 

1391 
1 in 34 

2272 
1 in 37 



98 
J in 307 

55 
1 in 409 

1S9 
1 in 308 

106 
1 in 440 

147 
1 in 574 



Consump- 
tion. 



Catarrh. 



104 1657 • 

1 in 290' 1 in 18 

125 1320 

1 in 180 1 in 17 

394 5186 



1 in 14S 
235 



1 in 11 
3041 



1 in 19S 1 in 15 

339 3401 

1 in 249 : 1 in 25 



From the preceding table it will be seen that comparatively fewer 
cases of pneumonia and pleuritis, hemoptysis and consumption 
occur in Van Diemen's Land than in any of the other colonies, and 
that as regards catarrh the proportion of cases also is less, with the 
exception of the Ionian Islands. 

With regard to other diseases, it appears that fevers are exceed- 
ingly rare, even compared with the healthy colonies above referred 
to. Dysentery and dyspepsia very common, and constipation ex- 
tremely so ; while diarrhoea is but little experienced. Affections of 
the liver, too, are more rare than in any other climate with which 
we are acquainted, but rheumatism is a disease of great frequency, 
and also of more than usual severity ; and it is very remarkable, 
that of the 30,102 cases, no fewer than 1134 were from toothache. 

Scrofula and glandular diseases are rare. Idiopathic intermittent 
fever, malignant sore throat, smallpox, measles, scarlet fever, hydro- 
phobia, &c. have not been met with in the colony. Hooping-cough 

1 In regard to the cases comprehended in this summary, it is to be observed, 
that the greater number of the acute diseases were brought on by intempe- 
rance, imperfect clothing, and exposure to wet and cold, and that the greater 
part of the patients were European convicts, of the most dissolute habits and 
broken constitutions. 



170 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

was once introduced, and for a short time extended as rapidly and 
widely as in England, but gradually became milder, and in a few 
months disappeared, There have been no epidemics in the colony 
except on two occasions. The first of these was an epidemic 
influenza, which carried off many persons infirm from age; the 
second was an epidemic continued fever. The diseases, both acute 
and chronic, are generally mild, and of comparatively short dura- 
tion, and yield easily to the usual remedies. 1 

The frequent and sudden changes of weather in Van Diemen's 
Land do not appear to be attended with the same hurtful conse- 
quences to the health as in other countries ; and it is remarked by 
Mr. Scott that c: situations apparently unhealthy are inhabited with 
the utmost freedom, without injury to the constitution, though in 
any other country they would probably be attended with inevitable 
destruction, or, at least, much hazard to human life." 

New Zealand. — The New Zealand group consists principally of 
two large islands, about 800 miles in length, and 100 miles in 
breadth, situated between 4S° and 34° of south latitude, and between 
166° and 179° east longitude. 

Both Islands are intersected in the greater part of their length by 
a chain of very high mountains perpetually covered with snow ; 
hence the country abounds in streams and rivers. 

The northern island of New Zealand appears to be more favoured 
by nature than the southern ; but both enjoy a temperate climate. 

The climate, especially of the northern island, is described by all 
who have visited the country as extremely pleasant and salubrious, 
and in every respect congenial to the European constitution. 

The temperature is never very high in summer, nor very low in 
winter, so that the annual range is within narrow limits. The 
following table is deduced from Major Cruise's thermometrical 
observations made during the autumn, winter, and spring, at 
various places on the west, north, and east coasts of the northern 
island, between the river Hokianga and the Thames. 



Mths. 


Aug. 


Sept. 


Oct. Nov. 


Dec.Uan. 


Feb. Mar. 


April. 


May. June. 


July. 


Max. 


64.00 


66.00 


68.00 77.00 






74.00 


69.00 


69.00J 68.00 


62.00 


Min. 


48.00 


51.00 


51.00 58.00 






65.00 

I 


57.00 50.00! 50.00 


40.00 


Mean 


57.62 


59.06 


60.48 63.41 






69.15 


63.46 


58.80; 57.70 


52.86 



During the period to which the above table applies, viz. from 
March to November inclusive, 86 days were rainy or showery, 78 
days were more or less windy, squally, foggy, dark, or hazy, and 
150 days were fine. 



'A Return of Medical and Surgical Diseases treated at H. M. Colonial 
Hospital, Hobart Town, Van Diemen's Land, for the Years 1821 to 1831. 
By James Scott, Esq., Colonial Surgeon. — In the Transactions of the Pro- 
vincial Medical and Surgical Association, vol. iii. 1835. 



SOUTHERN HEMISPHERE. 



171 



The climate of New Zealand appears to be mild, soft, and 
equable. Unlike New South Wales, it is not subject to drought 
and hot winds, but is plentifully supplied with rain, which appears 
pretty equally distributed throughout the year. The coasts are 
much exposed to high winds. 

Scrofula and consumption are said to be prevalent diseases 
among the natives; rheumatism, cutaneous diseases, and inflamed 
eyes are also common. 

The following is a comparative Table showing the Mean Temperature of Places 
in nearly corresponding Latitudes North and South of the Equator. 



PLACES. 


Yearly 
Mean. 


Spring. 


Summer. 


Autumn. 


Winter. 


Funchal, in 32° 30 North Lat. 
Malta, in 36° 55 North Lat. 
Rome, in 41° 52 North Lat. 
Nice, in 43° 20 North Lat. 

Sidney, in 34° South Lat. 
Port Johnston, 34° South Lat. 
Cape Town, in 34° South Lat. 
Hobart Town, in 43° S. Lat. 


64.56 
67.50 
60.70 
59.48 

63.68 
66.56 
66.56 
52.34 


62.20 
63.50 
57.65 
56.23 

65.57 
66.20 
65.66 

52.88 


69.33 
78.16 
72.16 
72.26 

72.14 

80.06 
74.30 
62.96 


67.23 
71.00 
63.96 
61.63 

62.87 
67.82 
67.28 
51.44 


59.50 
57.33 

48.90 

47.82 

57.56 
52.34 

58.64 
42.26 



These few remarks on the climate of our colonies in the Southern 
Ocean may, I hope, lead to the farther prosecution of the subject, 
which is one of great interest. Extended and accurate observations 
on the topography and climate of these regions will not only afford 
positive information regarding them, but may correct some of the 
opinions at present entertained respecting the causes of disease in 
the more unhealthy parts north of the equator. Some striking 
differences in the influence of certain localities upon health, have 
been already observed. It is remarked in " The Statistical Reports 
on the Health of the Navy," that on the South American station 
there are land-locked harbours, where, under a powerful sun, ships 
lie for months, or years, surrounded by a country abounding in 
marshes and rank vegetation, and all the other circumstances which 
elsewhere are considered the essential cause of the fevers which 
prove so destructive of life among Europeans, without the occur- 
rence of a single case of fever ; the crews, on the contrary, enjoying 
good health. Analogous to this is the circumstance above quoted 
from Mr. Scott's report that in Van Diemen's Land, situations which 
in other countries are found to exert a prejudicial influence on 
health, have there no such effect. 



172 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 



II 



MINERAL WATERS. 

The influence of climate, in the cure of some of the principal 
diseases treated of in the foregoing pages, may be so effectually 
promoted by the use of Mineral Waters, that a few observations on 
the proper application of these will form an appropriate supplement 
to this volume. It is not my intention to give here a particular 
account of the waters which 1 shall have occasion to notice: on this 
point the reader will find ample information in the various works 
published expressly on mineral waters, more especially on those of 
Germany. 

It may be remarked, in the first place, that the diseases in which 
mineral waters produce the most beneficial effects are those of the 
organs more immediately concerned in digestion and assimilation. 
The diseases of the skin, of the joints, of the nervous and uterine 
systems, in which mineral waters are so efficacious, very generally 
have their origin in disorder of the digestive apparatus; and the 
correction of this constitutes in general the first step in the cure. 

Disorders of the Digestive Organs. — Although the favourable 
influence of climate, and a suitable regimen, may allay irritation of 
the mucous surfaces, and induce a more healthy action of these and 
of the skin, something more active is often required in protracted 
and complicated cases of dyspepsia, to excite a freer and more 
steady action of the liver and other secreting organs connected with 
digestion. With this view I consider a well-directed course of 
mineral water very efficacious, and capable of effecting, in many 
cases, what no other remedy with which I am acquainted can 
effect. Mineral waters, by increasing the action of the secreting 
and excreting organs, powerfully contribute to relieve the vessels 
from the load which oppresses them; and thus often produce the 
most beneficial effects, not only in restoring the functions of the 
affected organs, but in improving the condition of the whole system. 
After a well-directed course of mineral water, the dyspeptic invalid 
enjoys a degree of activity of body and energy of mind to which he 
had long been a stranger; and if it be followed up by a residence, 
during the following winter, in a mild climate, the beneficial effects 
may be increased and confirmed. 

But as it is with every other remedy, so the degree of benefit to 
be derived from the use of mineral waters, will depend upon their 



MINERAL WATERS. 173 

proper adaptation to the individual case. Besides, it is to be 
remarked that every case of dyspepsia will not be benefited by 
mineral waters; on the contrary, many cases would be injured by 
the mildest of them. 

The selection of the particular water must depend upon the 
peculiar nature of the derangement and degree of susceptibility of 
the digestive organs, and upon the secondary disorders which may 
have been induced in other parts of the system. 

When the mucous surfaces are in a state of irritation, and the 
liver and abdominal venous system generally, are in a congested 
state, or when the functions of the uterus are defective, and there is 
not much relaxation of the system, the mineral waters of Ems, 
of Vichy, or of Plombieres, will be useful, particularly the two 
first. In cases where the skin is in an unhealthy state, or where 
dyspepsia is complicated with chronic bronchial disease, and no 
objection exists to an elevated, mountainous country, Cauierets, 
among the Pyrenees, will deserve a preference. 

When the abdominal viscera are in a more obstinately congested 
and torpid state, and when there does not exist much irritation of 
the mucous surfaces, the waters of Marienbad, Carlsbad, and 
Kissingen, will be more useful than any of these. When the 
digestive organs are easily excited, and a full action on the bowels 
is required, the cold aperient waters of Marienbad are indicated ; 
when the digestive organs are in a languid state, the more exciting 
waters of Kissingen will be preferable. The Carlsbad water, in its 
operation on the animal economy, may be considered as holding a 
medium place. In some cases, a course of the Ems water may 
precede, these with great advantage. When a state of atony of the 
stomach exists with general nervous debility ; or when the uterine 
system is debilitated and relaxed, without there being any organic 
disease, a cold chalybeate water, such as that of Pyrmont, or 
Schwalbach, will be very useful, and, in many cases, still more so, 
if preceded by a course of Kissingen water. The internal use of 
the two former is often advantageously combined with a course of 
warm bathing in the same. But to derive essential benefit from 
this class of waters, the digestive organs must be free from irritation, 
and the vascular system not in a state of plethora. In many cases 
a course of bathing at Ems forms a good preparative for the internal 
use of a chalybeate water. 

All these waters, at the same time that they are used internally, 
may generally be employed in the form of bath with great advan- 
tage. The temperature, the duration and repetition of the bath can 
be directed only by the physician residing at the place; and the 
same observation applies to the duration of the course, the quantity 
of water to be drunk, &c.- 

A short course of a cold chalybeate water may be employed very 
advantageously, in many cases, with the view of giving tone to the 
system, and confirming the effects of the deobstruent waters. When 
it is desirable to keep up some action on the bowels, the waters of 



174 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

Eger will answer well ; when the purely tonic effects of the waters 
are desired, those of Schwalbach or Pyrmont will be preferable. 

From a well-directed course of one or more of these waters, the 
dyspeptic invalid will, I believe, derive all the advantage which is 
to be obtained from this class of remedies. 

After the use of mineral waters, a residence for some time in a 
bracing air, or by the sea-side, will be very beneficial. When the 
intention is to pass the winter in Italy, the journey, if well con- 
ducted, is not likely to interfere with the good effects of the waters; 
but rapid traveling should be avoided, and whatever is likely to 
excite or heat the system. 

Bronchial Diseases. — There are several mineral waters on the 
Continent which have a high reputation in this class of diseases. 
Ems on the Rhine, Bonnes and Cauterets among the Pyrenees, 
and Mont oVOr in Auvergne, are held in great estimation. A resi- 
dence during one or two winters in Italy, and a course of one or 
other of these waters, according to the nature of the case, during 
the summer, afford, I believe, the most effectual means we possess 
in the more obstinate and deeply rooted cases of bronchial disease. 

The selection of the particular mineral water must depend on the 
nature of the case. Where the bronchial disease is accompanied 
with much general delicacy of constitution, and is connected with 
a congested state of the abdominal circulation, Ems deserves the 
preference. In cases of less delicacy, and those especially in which 
a mountain air promises benefit, or where the bronchial disease is 
complicated with chronic cutaneous eruptions, Bonnes, or Caute- 
rets, will be more effectual. In cases where there exists a very 
torpid state of the system, and especially a languid or defective 
action of the skin, or where the occurrence of the bronchial disease 
has coincided with the disappearance of any cutaneous eruption, 
the system of bathing adopted at Mont oVOr will, I believe, effect 
cures where the other waters fail. 

When the bronchial disease is consequent 'upon abdominal con- 
gestion and disorder of the digestive organs, a course of the Ems 
waters, followed by those of Carlsbad, IVIarienbad or Kissingen, as 
the case may indicate, will prove the most efficacious combination ; 
and a short course of chalybeate water will in some cases give 
permanency to the effects of the other waters. 

Asthma. — When treating of asthma in the first part of this work, 
it was remarked that when the disease is complicated with chronic 
irritation of the bronchial membrane, or of the digestive organs, or 
with a congestive state of the hepatic system, or an unhealthy con- 
dition of the skin, a course of warm mineral water will prove of 
much benefit. 

There is more difficulty, however, in selecting a mineral water 
for the asthmatic patient than for any other, as the source, most 
suitable in other respects, may be in a situation which decidedly 
disagrees with the asthma. However well suited the waters of the 
Pyrenees, or of Mont d'Or, might be as regards the bronchial 



MINERAL WATERS. 175 

disease, it would be useless to propose a residence at either of those 
places, to an asthmatic invalid who could not breathe at a great 
elevation, or to send him to Ems or Carlsbad, who could not live 
in a valley, although their waters might be admirably adapted to 
the bronchial or abdominal diseases, with which the asthma is com- 
plicated. I need not repeat here what I have already stated, regard- 
ing the use of the mineral waters, under the heads of Dyspepsia 
and Bronchial diseases. 

When asthma is complicated with disease of the heart, the use of 
mineral waters is inadmissible, and might be productive of serious 
injury. This point should always be carefully ascertained before 
mineral waters are prescribed in asthma. 

Gout. — The waters of Ems, of Carlsbad, of Marienbad, of Aix-la- 
Chapelle, and of Wiesbaden, here deserve particular mention. 

Used internally, the waters of Ems and Carlsbad are well calcu- 
lated to benefit the gouty constitution. The soothing effects of the 
former prove an excellent preparative, in many cases, for the more 
exciting but more deobstruent waters of the latter ; and these again 
may often be advantageously followed by bathing and the applica- 
tion of the douche at Wiesbaden, or Aix-la-Chapelle ; more espe- 
cially when frequent attacks of the disease have left the joints stiff 
and swollen. 

Before prescribing a course of mineral waters in gout, or indeed 
in any other disease, it should be ascertained that there is no disease 
of the heart or large vessels, or other organs in the chest ; and also 
that there is no disposition to cerebral congestion. 

Rheumatism. — Climate and mineral waters are very efficient 
remedies in chronic rheumatism. The baths of Aix ) in Savoy, 
have long enjoyed a high character in obstinate cases of this dis- 
ease. The waters of Cauterets and Bagneres-de-Luchon, among 
the Pyrenees and those of Aix-la-Chapelle are very beneficial, 
especially when the rheumatism is complicated with cutaneous 
affections. When the disease, however, is symptomatic of a 
deranged state of the digestive organs, a course of mineral water, 
calculated to remove this, will be more beneficial than any waters 
directed to the affection of the joints only. The cold sulphureous 
waters are often extremely useful in chronic rheumatism; and as 
one of the best of the class in this country, I may mention Strath- 
peffer, in Ross-shire. 

FACTITIOUS MINERAL WATERS. 

As many persons, in whose complaints mineral waters are indi- 
cated, must find it inconvenient to take a course of them at their 
sources, it may not be irrelevant to our present subject to say a few 
words respecting the Factitious Mineral Waters introduced into 
this country by the late Dr. Struve of Dresden. When in Ger- 
many, I made particular inquiries regarding the estimation in 
which these waters were held by the physicians of the different 



176 CLARK ON THE SANATIVE INFLUENCE OP CLIMATE. 

cities in which Dr. Struve had establishments. The information 
which I obtained, more especially at Berlin, where these factitious 
waters are extensively employed, was invariably in favour of their 
decided utility; and the remarkable similarity of their effects to 
those of the natural waters was generally admitted. The respect- 
ability of Dr. Struve, and his skill as a chemist, were also univer- 
sally acknowledged. 

After such satisfactory information, obtained from physicians of 
the highest character in Germany, I had no hesitation in prescribing 
the waters of the German Spa at Brighton in the same cases in 
which I should have recommended a course of the natural waters 
of Ems. Carlsbad, &c, had not the distance of these places presented 
obstacles to their employment. I have had abundant experience of 
the beneficial effects of Dr. Struve's waters in the diseases which 
are treated of in this work. And I feel satisfied that when their 
effects are more generally known to the profession, and the manner 
of using them better understood, they will be extensively and bene- 
ficially employed in a numerous class of diseases, and especially in 
disorders of the digestive organs, &c. At the same time, if the 
patient could conveniently take a course of the natural mineral 
water at its source, I should decidedly prefer this. 

In one respect, however, the patient has an advantage in taking 
the factitious mineral waters, as they may be changed according to 
the circumstances of the case during the progress of the course. 
For example, in many cases it will be very desirable to begin with 
a mild water, such as that of Ems, of Salzbrunnen, or of Saratoga, 
as a preparative for the more active and more exciting waters of 
Marienbad, of Carlsbad, and Kissingen ; and these again may be 
succeeded by a short course of the chalybeate waters of Eger, of 
Pyrmont, or of Spa. 

The warm sea-water bath will in the greater number of cases, 
promote the beneficial action of the waters ; and at Brighton this 
can be had very conveniently. The effects of the dry bracing air 
of this place will also contribute, more especially in relaxed con- 
stitutions, to the salutary operation of the waters. 



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PERIODS OF OBSERVATION, &C 


Howard, 1806—1816. 

Daniell, 1819—1823. 

Medical Observations, 1734 — 5. 

Edinburgh Medical Journal. 

S. Marshall, Esq. 1827 : Phil. Mag. 

Rev. E. Stanley, 1815—1824. 

Moss, 1825-26. 

Dr. Burney, 1827. 

Dr. Clarke, 1812—1814. 

Dr. Forbes, 1818-19. 

R. Thorn, Esq. 

Huettc, 1824-5. 

M. Mejan. 

L'Abbate Cesaris, 1763—1817. 

J. Fratelli Mojon, 1802. 

Ximenian Observatory. 

Cakindrelli, 1811—1823. 

Broschi, 1821—1824. 

Heineken, 1826. 


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Howard, 1807-16. 

Lord Gray, 1824-5. 

Edinb. Med. Jour. 

Dr. Scott. 

Dr. Martin, 1839-40. 

Bristol Ph. Ins. 1827-36. 

Mr. Stockton, 1823-4. 

Rev. E. Stanley. 

Dr. Chisholm, 1814-15. 

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Forbes, 1807-20. 

Mr. E.C. Giddy, 21 yrs. 

Huette, 1824-5. 

Christison, 1822-4. 

Poitevain, 1796-1806. 
Thulis and Blanpain. 
J. Fratel'i Mojon. 
Butori, 1777-1816. 
Ximenian Observ. 1825. 
Piazzini, 1815-7. 
Calandrelli, 1811-23. 
Brofchi, 1821-4. 
Heineken, 1826. 


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NOTES TO TABLES OF CLIMATE. 



1. Penzance. (a.) E. C. Giddy, Esq. Average of twelve years, from 

1821 to 1832 inclusive. From Dr. Forbes's Medical To- 
pography of the Land's End, in vol. ii. of the Transactions 
of the Provincial Medical and Surgical Association. 

(b.) Annual range, average extremes, 1821 — 1827. Monthly 
range, average extremes for twelve years, 1821 — 1832. 
Extreme range during twenty-one years, 84°— 19°=65°. 

(c.) Mean difference of 7 a. m., and 2 p. m. 

(d.) Forbes; Climate of Penzance. 

2. Sidmodth. Dr. Clarke; 1812 — 1814; mean of 9 a. m., and 2 p. m. Ed- 

inburgh Medical Journal. These observations do not 
give the true mean temperature, as they were not made 
with a register thermometer, or taken at those hours from 
which a close approximation to the real mean is obtained. 

3. Torquay. Dr. Barry ; January and February, 1838 — Dr. Foote, from 

December 1829, to July 1830, inclusive, and from Decem- 
ber 1830, to May 1831, inclusive. The winters of 1638 
and of 1829-30 were severe ; that of 1S30-31 mild. 

4. Undercliff. (a.) Col. Hewitt, Drs. Crawford, Grant, and Martin, 

during various years from 1829 to 1840, including the 
severe winter of 1829-30, and the unusually severe month 
of December, 1840, as also the mild winter of 1833-34. 

(b.) Dr. Martin, from two years' observations. 

(c.) The number of days (144) is the mean for 1839 and 
1840, both of which years were unusually wet, especially 
1839, when an almost unprecedented number of days 
proved rainy in the Undercliff, the number amounting to 
177 ; while in 1840, also a very wet season, 111 days were 
rainy. It should be also remarked that under the denomi- 
nation of rainy days is included those days on which any 
rain fell during either day or night. 

5. Hastings. Dr. Harwood; from September, 1832, to March, 1834, in- 

cluding the mild winter of 1833-4. R. Ranking, Esq.; 
from June 1837, to the end of 1840, including the severe 
winter of 1837-38. 

6. Chichester. Dr. Sandon ; 1794 — 1796. Mean of 8 a. m., and 8 p. m. ; 

Cross of Chichester, 32 feet above the level of the sea. 

7. Gosport. Dr. Burney ; corrected for each month by Brewster's table, 

ut infra. 
S. London. (a.) Howard ; from the observations made at the apartments 

of the Royal Society, Somerset House, 1797—1816; 1787 
— 1816, 50°456- Climate of London. Mean of maxima 
and minima, 1820—1822, 49°30. Daniell, Essay on the 
Climate of London. Range of mean annual temperature 
during thirty years, 4°8. Howard. 
(b.) Deduced from the average extremes ; 1820—1823. Dan- 
iell. Maximum temperature, during thirty years, 96°; 
13th July, 1808. Minimum during the same period — 5°; 
9th February, 1816- Howard. 



NOTES. 189 

(c.) Average difference of the higher and lower mean, 1797 
— 1806. Howard. Mean daily range according to Daniell, 
13°6 ; mean maximum, 56°1 ; mean minimum, 42°5. 

(d.) Mean difference of the temperature of the same hours 
of successive days ; calculated from Daniell's Meteorolo- 
gical Journal, 1820—1823. 
Sa. Environs of London, viz., Plaistow, Stratford, and Tottenham. How- 
ard, ut supra. 

(a.) Average extremes, 1807—1816. 

(b.) Average difference of the higher and lower mean, 1807 
to 1816. 
9. Chiswick. Horticultural Gardens, average of ten years, 1826 — 1835 
inclusive. 

10. Bushy Heath. Colonel Beaufoy ; 1824, 1825. Mean of extremes. 

Annals of Philosophy. 

11. Oxford. Dr. Robertson, Radcliffe Observatory; 1816 — 1821; mean 

of maxima and minima. Edinburgh Phil. Journal. 

12. Cheltenham. Moss; 1821,1825,1826; mean of extremes. Thomas's 

Practical Observations, $c. 

13. Bristol. Bristol Institution; average of three years, 1834—1836, 

both inclusive. These tables, although made with the 
register thermometer, are not so perfect as could be de- 
sired, as they do not note more than twenty-seven days 
in any month, and in one or two months, so few as 14. 

(b.) The calculations are only an approximation to the 
truth, as the quantities were never noted for more than 
twenty -six days in the month, and sometimes only twenty- 
three. 

(c.) The number of days here given is only an approxima- 
tion to the truth, as there were never more than twenty- 
seven days noted in any month, and sometimes so few as 
twenty-three. And the weather is frequently marked fine 
when the pluviometer indicates a fall of rain ; this pro- 
bably arises from the fall having taken place during the 
night. 

14. Helston, Cornwall. Mr. Moyle ; 1821—1828; 105 feet above the level 

of the sea. 

15. Exeter. Dr. Barham. Average of eight years, 1829 to 1836 both 

inclusive. 

16. New Malton, Yorkshire. Mr. Stockton; 1823, 1824; ninety-two feet 

above the level of the sea. Annals of Philosophy. 

17. Alderley Rectory, near Knutsford, (Cheshire.) (a.) The Rev. E. 

Stanley ; 1815, 1824, mean of 8 a. m., 2 p. to., and 10 p. m., 
corrected for each month by Dr. Brewster's table, as de- 
duced from the Leith Fort Observations. 

(b.) Average of extremes of ten years. Extreme range in 
ten years, 84°— 1°=83. 

(c.) Mean difference of 8 a. m. and 2 p. M. Edinburgh 
Philosophical Journal, xxiv. 

18. Kendal. Dalton. 

19. Bute. (a.) Robt. Thorn, Esq., of Ascog. Average of nineteen 

years, 1821 to 1839 inclusive; the observations taken 
hourly for twelve years during that period ! 

(b.) Deduced from the data in Table X. See the following 
note. 
Note to Table X. The maxima and minima of the barometer and thermo- 
meter in the bottom line, are the highest and lowest points 
reached by the mercury during the whole of the 19 years. 

Column 7 gives the greatest difference of temperature during 



190 



CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 



the whole of the nineteen years, for each month, and for 
the whole nineteen years. 
The mean of the barometer and thermometer, as given in 
the table, is not that between the maxima and minima, 
but have been deduced by dividing the sum of all the de- 
grees, noted during the whole nineteen years, by the total 
number of observations made during that time. 

20. Leith. (a.) Dr. Brewster; from the valuable observations made at 

Leith Fort, 1824, 1825. 
(b.) "The measure of the daily change of temperature." 
Brewster. Edinburgh Journal of Science. 

21. Edinburgh, (a.) A. Adie, Esq.; 10 a. m., 10 p. m., 1824-1825; at 

Canaan Cottage, one and a half miles south of Edinburgh 
Castle, three miles from the sea, and 260 feet above its 
level. Edinburgh Journal of Science. Mean of year, 
47°8; Winter, 38°G; Spring, 46°4; Summer, 58°2 ; Au- 
tumn, 48°4;— warmest month, 59°4, coldest month, 38°3. 
Playfair. 

22. Elgin. Observations taken at Elgin Institution, by common thermo- 

meter, during the years 1835, 1836, 1838. These obser- 
vations being made at different times in the day during 
the various years, are of course comparatively of little 
value as determining the true mean temperature. 1835. 
8i a. m., 3^ p. m. ; 1836, 9 a. m., 9 p. m. ; 1838, 9 a. m., 3 p. m'. 

23. Kinfauxs Castle. Lord Gray : 10 a. m., 10 p. m., 5140 feet above the 

level of the sea; 1825, 48°319; mean Of maximum and 
minimum 49°048. Edin. Phil. Journ. xxiv., xxviii. 

24. Cove of Cork. Dr. Scott. Average of three years. From 1834 to 

1837. Dublin Journal of Medical Science. The mean 
monthly temperature of Cove for 1838 (of which the 
months of January and February were unusually severe,) 
contrasts advantageously with that of several other places 
in Britain for the same year. 

25. Dublin. Kirwan. 

26. County Antrim. 1814. Edinburgh Medical Journal. 

27. Jersey. Dr. Hooper. Average of five years. From 1831 to 1835: 

generally moderate winters, and including the mild winter 
of 1833-34. 

28. Isle of Man. Average of five years from 1824 to 1828, both inclusive. 

These observations only approximate to the true mean, 
having been taken by common thermometer, at 9 a. m. 
and 11 p. m. 

29. Geneva. (a.) Pictet. Mean of sunrise and 2 p.m.; 1080 feet above 

the level of the sea. Saussure, 50°74 ; Berne, 49°30 : dif- 
ference of warmest and coldest month, 36°12 ; Zurich, 
47°8 : difference of warmest and coldest month, 31°10. 
(b.) Difference of the mean of sunrise and of 2 p. m. Annual 
range at Sion, 92°— 9°=83° 1819, 92°+2°=94°. 

30. Paris. (a.) Royal Observatory; mean of extremes ; M. Boward, 

1806—1826. 

31. Nantes. Huette, Observatory ; 46 metres above the level of the sea. 

and 25 from the'gr° und 5 1824 > 1S25 > 55°94. Duplessis 
and Bondin. 

32. Bourdeaux. Humboldt, from Guyot. 

33. Pau. (a.) Mr. Christison ; at Chateau Billere, from September, 

1822, to July, 1824 ; and at Pau, Hotel de Place, from 
July, 1824, to May, 1825. 

(b.) Mean difference of 9 a. m., and noon. Range at Tou- 
louse, 81°— 24°=57°. 

(c.) Mean difference at 9 a. m., 12 a. m., and 4 p.m. 



NOTES. 



191 



34. MONTPELIER. 



35. Avignon. 



36. Marseilles. 



37. Toulon. 



38. Nice. 



39. 

40. 



42. 
43. 



Poitevin ; 1796 — 1806. Sur le Climat de Montpelier. 
58° mean of twelve years ; Mejan. Nismes, 60°26. 

(a.) M. Guerin ; Musee Calvet; about seventy feet above 
the level of the sea ; sunrise and 2 p. m. 

(b.) Mean difference of sunrise and 2 p. m. Extreme iange 
in twelve years, 101°— 12°=89°. 

(a.) Thulis and Blanpain, Royal Observatory ; about 160 
feet above the level of the sea ; 1806 — 1815- Statistique 
des Bouches du Rhone. 60°10. St. Jaque de Sylvabelle. 
Aix 56°66 ; 309 feet above the level of the sea. 

Range at Marseilles, 93°— 20°=73°; at Aix 102°— 19°=83°. 
M. Burel, Naval Hospital; 1749—1781. Statistique des 
Bouches du Rhone. 

(a.) M. Risso ; 1806 — 1825; mean of 8 a. m. and of 8 p. m., 
corrected by Brewster's Table. Histoire Naturelle de 
V Europe Meridionale. Dr. Skirving. November, 1820, 
to February, 1826; mean of sunrise and 2 p. m. Both 
these series of observations nearly coincide. 

(b.) Dr. Skiiving; mean difference of sunrise and 2 p. m. 

(c.) Idem : the mean difference of successive days at sun- 
rise and at 2 p. m. 

I. Fratelli Mojon. Humboldt, 60°26. 

(a.) Dr. Peebles and others. 

(b.) Mean difference, of 8 a. m. and 2 p. m. 

(a.) Broschi, Observatory at Capo di Monte ; 148 metres 
above the level of the sea ; mean of sunrise and 2 p. m. ; 
1821—1824. Toaldo, 63°5. Palermo, 63°60. Scina, Topo- 
grqfia di Palermo. 

(b.) Mean difference of sunrise and 2 p. m. Extreme range 
during five years 95° — 26°=69. 

(c.) Mean difference of successive days at sunrise and 2 p.m. 

Army Medico-Statistical Reports. 
Mediterranean, General Temperature of. Mr. Wm. Black ; Edin- 
burgh Philosophical Journal, September, 1821. Mean 
of three years, affording a view of what temperature a 
person might be exposed to, sailing indiscriminately in 
different parts of the Mediierranean. 

Dr. John Davy. Mean of the thermometer for the years 
1821—27. 
Baths of Lucca. Dr. Todd. 

Camajore. State of Lucca, at the foot of the Apennines, 105 feet above 
the level of the sea. 

(a.) II Canonico Butori ; 1777—1816. Lucca, 60°44 ; forty 
feet above the level of the sea. 

Range 88°50 — 24°00=64°50 ; extreme range in forty years 
99°— 18°=8l°. 



Genoa. 
Leghorn. 



41. Naples. 



Malta. 



44. Corfu. 



45. 
46. 



47. 

48. 



49. 
50. 



Sienna. 
Florence. 



Pisa. 

Rome. 



AtBelvidera; 1786 — 1791; furnished by Profes. Grotanelli. 

Ximenian Observatory, Scuole Pie ; 205 feet above the 
level of the sea ; mean of three daily observations ; 1824 
— 1825. Temperature within doors 6l°50, out of doors 
58°75. Humboldt 61°52. Bologna 56°30. Verona 55°76. 
Venice 56°48. Padua 56°30. 

Deduced from several Journals. 60°0. Piazzini. 

(a.) Observatory of the Roman College, 163 feet above the 
level of the Mediterranean, and 101 feet from the level of 



the ground ; 1811- 
servation at 9 p. m 



1823. The mean of the evening ob- 
has been preferred to the mean of 7 



192 CLARK ON THE SANATIVE INFLUENCE OF CLIMATE. 

a. m. and 2 p. m. Effemeride Astronomiche 60°08. Calan- 

drelli. 63°44. W. Humboldt. 
(*) It freezes on an average about ten times in every year, and 

snow falls about twice a year. 
(b.) Mean difference of 7 a. m. and 2 p. m. Extreme range 

during thirteen years 101°— 22°=89°. 
(c.) Mean difference of successive days at 7 a. m., 2 p. m., 

and at 9 p. m. 

51. Cadiz. Dr. Skirving; September 1810 to August 1812, on board 

ship in Cadiz Bay, at noon and 6 p. m., corrected by 
Brewster's table; Madrid 59°0; 2040 feet above the level 
of the sea. Lisbon 62°. Balbi. Essai Statistique sur le 
Portugal. 

52. St. Michael's. Thomas Blunt, Esq., 1825— Mean of 8 a. m. and 8 p.m.* 

53. Madeira, (a.) Dr. Heineken, Funchal : 1826. Mean deduced from 

mean maxima and mean minima, Gourlay; mean of ex- 
tremes ; 1793 — J802; mean annual temperature, 66°21. 
Winter, 62°53 ; Spring, 63°00 ; Summer, 70°50; Autumn, 
69°20; January, 61°40; February, 62°20 ; March, 61°30; 
April, 62°10; May, 65°60; June, 67°40; July, 71°10; 
August, 72°90; September, 72°80; October, 69°20 ; No- 
vember, 65°60; December, 63°00. Heberden 67°30 ; mean 
annual temperature, as corrected by M. Schouw. 

(b.) fGourlay, average of eighteen years. (?) Heineken, 1826. 

(c.) Mean difference of maxima and minima. 

(d.) Mean difference of successive days at 10 a.m. and 10 p.m. 

54. Santa Cruz, Isle of Teoeriffe, Von Buch, from the Journal of Don 

Francisco Escolar ; mean of sunrise and of noon. 

55. Cairo. Humboldt, from Nouet. 

* See also Dr. Bullar's Observations, p. 144 of this work. 



CONTENTS 



Page 

INTRODUCTION, 11 

General Remarks on the influence of Climate on Disease, - 14 

Traveling-, -------- ib. 



PART THE FIRST. 
ON DISEASES. 

DISORDERS OF THE DIGESTIVE ORCANS, ... 17 

Gastritic Dyspepsia, ------ jb. 

Atonic Dyspepsia, - - - - - - -18 

Nervous Dyspepsia, ----- _ 19 

The more recent and simple cases of Dyspepsia, - - 22 

The more protracted and complicated cases of Dyspepsia, - 25 

PULMONARY CONSUMPTION, 30 

Tuberculous Cachexy, ------ ib. 

Hereditary Predisposition, - - - - - 32 

Exciting Causes, - 33 

Choice of Climate, ------ - 36 

Artificial Climate, -------41 

Respirator, --------43 

DISEASES OF THE LARYNX, TRACHEA, AND BRONCHI, 44 

Asthma, -------.47 

Pure Nervous A3thma, ------ 48 

Humid Asthma, ------- ib. 

Cardiac Asthma, ------- ib. 

GOUT, 48 

CHRONIC RHEUMATISM, 49 

DELICACY IN CHILDHOOD AND YOUTH, - - - ib. 

Dyspepsia in Children, ------ 50 

CLIMACTERIC DISEASE, 53 

DISORDERED HEALTH FROM VARIOUS CAUSES, - - 55 

From a Residence in hot Climates, ib. 

Convalescence, &c - - ■ - ib. 
2— 3 14 dark 



194 CONTENTS. 

PART THE SECOND. 
ON CLIMATES. 

PAGE 

INTRODUCTORY REMARKS, 57 

Ventilation, ------- ib. 

Unhealthy Residences, ------ 58 

Directions for Invalids making a Change of Climate, - - 60 

CLIMATES OF ENGLAND, 64 

London, -------- 65 

The South Coast, ------- 66 

Hastings, ------- 67 

St. Leonard's, ---.... 59 

Brighton, ------- ib. 

Isle of Wight— Undercliff, - - —■.:••« 70* 

Southwest Coast, ------.74 

Salcombe, -----.-76 

Torquay, - - - '- - - - ib. 

Dawlish ------.. 77 

Exmouth, Salterton. ------ ib. 

Sidmouth, ----._. 73 

Cornwall, Land's-End, ------ §0 

Penzance, ------- ib. 

Falmouth, Flushing, ------ 83 

West of England, ------ 85 

Clifton, -------- ib. 

Bristol Hot Wells, - - - - - 86 

Island of Bute, ....... 88 

Cove of Cork, - - - - - - - ' 89 

Summer Residences in England, ----- 95 

The Channel Islands, ------ 96 

Jersey, ---.---- ib. 

CLIMATE OF FRANCE, 98 

Southwest of France, Pau, - - - - - ib. 

Southeast of France, ------ 101 

Montpelier, - - - - - - - 103 

Marseilles, - - - - - - - ib. 

Hyeres, -------- 104 

CLIMATE OF NICE, 105 

Villa Franca, 110 

Menton and San Remo, ------ ib. 

CLIMATE OF ITALY, Ill 

Genoa, -------- ib. 

Florence, - - - - - - - 112 

Pisa, -.--.--. 113 
Rome, - - - - - - - -114 

Naples, -------- 1,21 



CONTENTS. 195 

CLIMATE OF MALTA, 123 

SUMMER RESIDENCE ON THE CONTINENT, - - 126 

Environs of Naples : — ...... 127 

Capo di Monte, Sorento, Castelamare, Cava, - - - ib. 

Sienna, - - - - - - - 123 

Baths of Lucca, ------- ib. 

Switzerland, - - - .- - - 129 

ATLANTIC CLIMATE, 130 

Eastern Atlantic, - - - - - - 131 

Madeira, -------- ib. 

Canaiies, - - - - - - - 140 

Azores, ..---... 142 

Western Atlantic, ... . 145 

Bermudas, ------- ib. 

Bahamas, ....... 148 

The West Indies, ------- 150 

Jamaica, -------- 157 

Barbadoes, ------- 153 

St. Vincent, ------- ib. 

Antigua, St. Kitt's, Nevis, - - - - - 159 



APPENDIX I. 

CLIMATES OF THE SOUTHERN HEMISPHERE, - - 163 

Cape of Good Hope, - f- - - - - ib. 

Cape Town, - - - - - - - ib. 

Eastern Province, ------ ib. 

Australian Climate. - - - - - - 165 

New South Wales, ------ ib. 

South Australia, - - - - - - - 166 

Swan River, ------- ib. 

Van Diemen's Land, - - - - - - ib. 

New Zealand, - - - - - - -170 



APPENDIX II. 
MINERAL WATERS. 

In Disorders of the Digestive Organs, - - - - 1 72 

Bronchial Diseases, Asthma, Gout, Rheumatism, - - 174 

Factitious Mineral Waters, - - - - 175 



196 CONTENTS. 



APPE1NDIX III. 

TABLES OF CLIMATE, &c. 

I. Showing the mean temperature for each month, each season, and for the 

whole year. 
II. Showing the difference between the mean temperature of each season, 
and of each month. 

III. Containing the annual and monthly ranges of temperature. 

IV. Containing the daily range of temperature. 

V. Showing the variations of temperature between each successive day, for 

each month, and for the whole year. 
VI. Account of the temperature experienced by an invalid confined to the 

house at Nice and Torquay, compared with the temperature of the 

external air. 
VII. Showing the range of the barometer for each month and for the whole year. 
VIII. Showing the mean quantities of rain, in inches and parts of inches, for 

each month and for the whole year. 
IX. Showing the relative prevalence of different kinds of weather for each 

month and for the whole year. 
X. Meteorological Table for Bute — from 1821 to 1839, inclusive, deduced 

from registers of observationAmade (hourly for twelve of the nineteen 

years) at Rothsay Cotton Mills, and at Ascog, by Robert Thorn, Esq. 
Notes to Tables of Climate. 



April, 1843. 



OS 

ANATOMY, MEDICINE, SURGERY, 

AND 

THE COLLATERAL SCIENCES. 




PUBLISHED BY 

ED. BARRINGTON & GEO. D. HASWELL, 

PHILADELPHIA. 



KH™ ^CIBZ; 



PILCHEB. OZT THE EAR. 

A TREATISE on the STRUCTURE, ECONOMY, and DISEASES of 

the EAR ; being the Essay for which the Fothergillian Gold Medal was 
awarded by the Medical Society of London. By Geo. PixcHER,late Lec- 
turer on Anatomy, and Lecturer on Surgery at the Theatre of Anatomy 
and Medicine, Webb St., Borough, and Senior Surgeon to the Surrey 
Dispensatory. First American, from the 2d London edition, with Notes 
and numerous illustrative Plates. 



STANDARD MEDICAL WORKS 



PUERPERAL FEVER. 

THE HISTORY, PATHOLOGY, AND TREATMENT OF PUER- 
PERAL FEVER AND CRURAL PHLEBITIS. By Drs. 
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DIGESTION, 

DERANGEMENTS, PRIMARY and REFLEX, of the ORGANS of 
DIGESTION. By Robert Dick, M.D., author of " A Treatise on 
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SEHxmoxioair. 

OUTLINES OF PATHOLOGICAL SEMEIOLOGY. Translated 
from the German of Professor Schill. With copious notes by 
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MEDICAL EXPERIENCE. 

CURIOSITIES OF MEDICAL EXPERIENCE. By J. G. Mil- 
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" Curiosities of Medical Experience. By J. G. Millingen, Surgeon to the Forces, etc. 
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PUBLISHED BY BARRINGTON AND HASWELL. 



MATERIA IttSDXCA. 

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&IVER AffD S7X.EEOT. 

DISEASES OF THE LIVER AND BILIARY PASSAGES; 
by William Thomson, one of the Physicians of the Royal Infir- 
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complete accounts of the various dynamic disorders and organic changes incident to the 
organ hitherto given, but these states are described and distinguished in a much clearer 
and more methodical manner than any other treatise yet before the public. In accordance 
with this we observed, also, in the therapeutic principles and precepts established by the 
author, a much more rational development and application of therapeutic measures than it 
has yet been our fortune to witness." — Edinburgh Med. and Sur. Journal, October, 1841. 

" The work before us is an excellent compilation of the subject of hepatic affections, 
functional and structural ; and, as such, it is infinitely more valuable to practitioners and 
students, than any original essay, however ably executed. We cannot do better, therefore, 
than strongly recommend the work as the best in the English language, on the important 
subjects of which it treats.— Medico-Chirurg. Rev., October, 1841. 

" These two works, when united, form, we may safely say, one of the most valuable and 
attractive volumes on this important class of diseases which have been issued from the 
press. We may, en passant, remark, that the volume is got up in a very superior style."— 
N. Y. Lancet, March 26, 1842. 

CLINICAL REMARKS ON SOME CASES OF LIVER ABSCESS 
PRESENTING EXTERNALLY. By John G. Malcolmson,M.D. 
Surgeon Hon. E. I. C. Service, Fellow of the Royal Asiatic Society, and 
the Geological Society, London, 1 vol. 8vo. 



VBOTEREAL. 

HUNTER'S TREATISE ON THE VENEREAL DISEASE. With Notes 
by Dr. Babington. With Plates. 1 vol. 8vo. 

"Under the hands of Mr. Babington, who has performed his task as editor in a very 
exemplary manner, the work has assumed quite a new value, and may now be as 
advantageously placed in the library of the student as in that of the experienced sur- 
geon."— Brit. 8? For. Med. Rev. 

" The notes, in illustration of the text, contain a summary of our present know- 
ledge on the subject; the manner in which these notes are constructed is at once clever 
and perspicuous; and the modes of treatment prescribed, spring from aright apprehension 
of the disease. We would recommend to the reader the note on the primary venereal 
sore; the note itself is an essay in every word of which we fully concur."— Med. Oaz. 

A PRACTICAL TREATISE ON~VENEREAL DISORDERS. AND 
MORE ESPECIALLY ON THE HISTORY AND TREATMENT 
OF CHANCRE. By Philippe Ricord, M.D., Surgeon to the Venereal 
Hospital at Paris. 1 vol. 8vo. 



STANDARD MEDICAL WORKS 



GRAVES 6L GERHARD. 

CLINICAL LECTURES; by Robert J. Graves, M.D., M.R.S.A., 

Professor of the Institutes of Medicine in the School of Physic, 
Trinity College, Dublin, with additional Lectures and Notes, by 
W. W. Gerhard, M.D., Lect. on Clin. Med. to the Univ. of Penn., 
Physician to the Philadelphia Hospital, Blockley, etc. 1 vol. 8vo. 

"In the volume before us, a seriesof clinical lectares by Dr. Gerhard is given, and forms a 
most appropriate and acceptable addition to those of Dr. Graves. Between these two dis- 
tinguished physicians we can trace many points of resemblance. We find in both the same 
professional zeal,— the same powers of close and correct observation, — the same discrimi- 
nating tact, — the same disregard of idle theory,— and the same decision in the application 
of ri^ht principles. No student or practitioner should be without this volume. Jt is in itself 
a library of practical medicine."— N. Y. Lancet. 



DISEASES Or CHILDREN. 

TREATISE ON THE DISEASES OF CHILDREN; WITH 
DIRECTIONS FOR THE MANAGEMENT OF INFANTS; 

by the late Michael Underwood, M.D. From the ninth English 
edition, with Notes, by S. Merriman, M.D., and Marshall Hall, 
M.D., F.R.S., etc. ; with Notes, by John Bell, M.D.. etc., of 
Philadelphia. 1 vol. 8vo. 



JETXOXiOGIT. 

ARET.EUS ON THE CAUSES AND SIGNS OF ACUTE and 
CHRONIC DISEASE. From the Greek, by T. F. Reynolds, 
M.B., F.L.S., &c, &c. 1 vol. 8vo. 

" The correct detail of symptoms, the nervous style, the graphic delineation of disease, 
displayed in this author's work, the poetic and quaint fancies scattered throughout, give a 
certain value and interest, that may fairly excuse an attempt to reinvest part of them in a 
vernacular garb." 

" We certainly have no hesitation in recommending this curious volvime to the notice of 
our readers. Its price is a mere trifle."— New York Lancet. 



EVES. 

A MANUAL OF THE DISEASES OF THE EYE. By S. Littell, 
Jr., M.D., one of the Surgeons of the Wills' Hospital for the Blind 
and Lame, &c, &c. 

"We confidently recommend the work of Dr. Littell to the senior, as well as to the 
junior, members of the profession. It is replete with information ; yet so terse in style, 
and compressed in bulk, as at once to entice and repay perusal. It is no small triumph 
to the author to be able to say that he has introduced almost all that is valuable, and 
everything absolutely necessary to the student within the compass of 200 pages, and we 
would deliberately recommend our young friends to read this work."— Br. Sc For. Med. Rev. 



GUMS. 

THE GUMS; with late Discoveries on their Structure, Growth, Connections, 
Diseases, and Sympathies. By George Waite, Member of the London 
Royal College of Physicians. 1 vol. 8vo. 



TEETH. 

A TREATISE ON THE TEETH. By John Huntkr. With Notes by 
Thomas Bell, F.R.S. With Plates. 1 vol. 8vo. 
" The treatise on the teeth is edited by Mr. Bell, a gentleman accomplished in his 
art. Mr. Bell has studied his subject with the greatest minuteness arid care; and in ap- 
propriate notes at the foot of the page corrects the author with trie air of a gentleman, 
and the accuracy of a man of science. The matter contained in these short notes forms 
an ample scholum to the text; and without arming at the slightest display of learning, 
they at the same time exhibit a ready knowledge on every point, and an extensive in- 
formation both of comparative anatomy and pathology— Med. Gazette. 



PUBLISHED BY BARRINGTON AND HASWELL. 



CHEST. 

LECTURES on the PHYSIOLOGY and DISEASES of the CHEST, 

including the Principles of Physical and General Diagnosis, illustrated 
chiefly by a rational Exposition o£ their Physical Signs; with new re- 
searches on the sounds of the heart. By Charles J. B. Williams, M.D. ; 
Third edition, 1 vol. 8vo. 

"Evidently written by a man thoroughly acquainted with his sul ject."— Lancet. 

" We strongly recommend this work to the attention of auscultators."— Med. Chir. Rev. 

"I gladly avail myself of this opportunity of strongly recommending this very valuable 
work."— Br. Forbes's Translation of Laennec. 

"Of all the works on this subject, we are inclined much to prefer that of Dr. Williams."— 
Med. Gaz. 

LECTURES ON THE DIAGNOSIS, PATHOLOGY, AND TREAT- 
MENT OF THE DISEASES OF THE CHEST. By W. W. 
Gerhard, M.D., Lecturer on Clinical Medicine in the University of 
Pennsylvania, etc., etc. 1 vol. 8vo. 

"A series of clinical lectures — concise, lucid, and eminently instructive. We have no 
more able expositor of diseases of the chest than Dr. Gerhard, and any work of his on these 
important subjects is certain of grateful acceptance by his professional brethren."— Neto 
York Lancet. 

" To our readers, therefore, we recommend the book of Dr. Gerhard as the fullest and 
most judicious manual, in relation to the diseases of the chest, which they can procure." — 
Western and Southern Recorder, June, 1842. 

" These lectures constitute a useful and practical digest of the existing knowledge of the 
diseases of the chest (lungs and heart)." — Bulletin of Medical Science. 

A PRACTICAL TREATISE on~~the PRINCIPAL DISEASES of the 
LUNGS. Considered especially in relation to the particular 
Tissues affected, illustrating the different kinds of Cough. By 
G. Hume Weatherhead, M.D., Member of the Royal College of Physi- 
cians.Lecturer on the Principles and Practice of Medicine, and on Materia 
Medica and Therapeutics, &c. &c. 1 vol. 8vo. 

PRACTICAL OBSERVATIONS onl)ISEASESof the HEART, LUNGS, 
STOMACH, LIVER. &c, OCCASIONED by SPINAL IRRITA- 
TION: AND ON THE NERVOUS SYSTEM IN GENERAL, AS A 
SOURCE OF ORGANIC DISEASE. Illustrated by Cases. By John 
Marshall, M. D. 1 vol. 8vo. 



CUTANEOUS DISEASES. 

A PRACTICAL TREATISE ON DISEASES OF THE SKIN, arranged 
with a view to their Constitutional Causes and Local Character, &c. 
By SAMUEL PLUMBE, late Senior Surgeon to the Royal Metropolitan 
Infirmary for Children, &c. Illustrated with Splendid Coloured Copper- 
plate and Lithographic Engravings. ] vol. 8vo. 

Pldmbe on Diseases of the Skin.—" This excellent Treatise upon an order of diseases, 
the pathology of which is, in general, as ohscure as the treatment is empirical, has just 
been republished, edited by Dr. John Bell, of this city. We hail with pleasure the appear- 
ance of any new work calculated to elucidate the intricate and ill-understood subject of 
skin-diseases. The late Dr. Mackintosh, in his Practice of Physic, recommends it as the 
1 best pathological and practical treatise on this class of diseases, which is to be found 
in any language.'"— Phil. Med. Exam., Jan. 17, 1838. 

" This work is one of the most excellent on the Diseases of the Skin in the English 
language."— West. Jour, of Med. and Phys. Sciences, Jan. 1838. 



BANDAGES AND BANDAaXXffa. 

THE SURGEON'S PRACTICAL GUIDE IN DRESSING, and in the 
Methodic APPLICATION of BANDAGES. Illustrated by one hun- 
dred engravings. By Thomas Cutler, M.D., late Staff Surgeon in the 
Belgian Army. 2d American from the 3d London edition. 

"The Author seems to have spared no pains in procuring correct descriptions of all the 
surgical apparatus, at present employed in bandaging and dressing, both at home and 
abroad. He has given numerous illustrations, in the form of well executed woodcuts, and 
has altogether produced what we conceive to be a very useful, and by no means an ex pen- 
sive publication."— Medical Gazette. 



STANDARD MEDICAL WORKS 



TETANUS. 

A TREATISE ON TETANUS, being the ESSAY for which the Jackson ian 

Prize was awarded by the Royal College of Surgeons in London. By 

Thomas Blizard Curling. Assistant Surgeon to the London Hospital, &c. 

" This book should be in the library of every surgeon and physicran. It is a valuable 

work of reference. It does not pretend to originality, for originality on such a subject 

was not wanted. But a compendium of facts teas wanted, and such a compendium is this 

volume. We cannot part from Air. Curling without thanking him for the information 

we have received in reading his work, and for the matter it has enabled us to offer 

to our readers."— .Medico- C/i ir. Rcr. 



BLOOD, INFLAMMATION, ETC. 

TREATISE ON THE BLOOD, INFLAMMATION, AND GUN-SHOT 
WOUNDS. By John Hunter, F.R.S. With Notes, by James F. Palmer, 
Senior Surgeon to the St. George's and St. James's Dispensary, &c, &c. 
1 vol. Svo. 

LECTURES ON BLOOD-LETTING. By Henry Clutterbuck, M.D. 

1 vol. Svo. 

HISTORICAL NOTICES ON THE OCCURRENCE OF INFLAMMA- 
TORY AFFECTIONS OF THE INTERNAL ORGANS AFTER 
EXTERNAL INJURIES AND SURGICAL OPERATIONS. By 
William Thompson, M.D., &c. &c. 1 vol. Svo. 

A TREATISE ON INFLAMMATION. By James Macartney, F.R.S., 
F.L.S., &c, «fcc. Member of the Royal College of Surgeons, London, 
&c, &c. 1 vol. Svo. 

LECTURES ON THE BLOOD, and on the CHANGES which it 
undergoes during DISEASE. By F. Magendie, M.D. 1 vol, Svo. 



ACTIIKAXi (ECONOMY*. 

OBSERVATIONS ON CERTAIN PARTS OF THE ANIMAL CECO- 
NOMV, Inclusive of several papers from the Philosophical Transactions, 
&c. By John Hunter. F.R.S. , &.c, &c. With Notes by Richard Owen, 
F.R.S". lvol.8vo. 



raiDWIFER.1T. 

LECTURES ON THE PRINCIPLES AND PRACTICE OF MID- 
WIFERY. By James Bluxdell, M.D. Edited by Charles Severn, 
M.D. 1 vol. 8vo. Just published. 

" The eminently fluent and agreeable style — the large and accurate information — the 
great experience — and originaf mind of Dr. Blundell have secured for him a very enviable 
reputation as a public lecturer. It is impossible to read these lectures without being delighted 
— it is equally impossible to avoid being instructed. Were these discourses more'generally 
diffused and studied here — were their "sound and judicious directions recollected and their 
salutary cautions observed, we would hear of fewer cases of malpractice. This work forms 
a complete system of midwifery, with the diseases of th j puerperal state and of the infant. 1 '— 
N. Y. Lancet. 

A PRACTICAL TREATISE on MIDWIFERY; Containing the Results 
of Sixteen Thousand Six Hundred and Fifty-four Births, occurring in 
the Dublin Lying-in Hospital. By Robert Collins, M.D., Late Master 
of the Institution. 1 vol. Svo. 
" The author of this work has employed the numerical method of M. Louis ; and by 
accurate tables of classification, enables his readers to perceive, at a glance, the conse- 
quence? f>f the diversified conditions, in which he saw his patients. A vast amount of 
information is thus obtained, which is invaluable to those who duly appreciate precision 
in the examination of cases." — Bait. Chron. 

A PRACTICAL COMPENDIUM OF MIDWIFERY; being; the 
Course of Lectures on Midwifery and on the Diseases of Women 
and Infants delivered at the St. Bartholomew's Hospital by the 
late Robert Gooch, M.D. Prepared for Publication by George 
Skinner, Member of the R. Coll. of Surg., Lond. 1 vol. Svo. 



PUBLISHED BY BARRINGTON AND HASWELL. 



ARMSTRONG'S LECTURES. 

LECTURES on the MORBID ANATOMY, NATURE, and TREAT- 
MENT of ACUTE and CHRONIC DISEASES. By the late John 
Armstrong, M.D. ; Author of " Practical Illustrations of Typhous and 
Scarlet Fever," &c. Edited by Joseph Rix, Member of the Royal Col- 
lege of Surgeons, i vol. 8vo. 

The British and Foreign Medical Review says of this work : 
"We admire, in almost every page, the precise arid cautious practical directions; the 
striking allusions to instructive cases; the urgent recommendations of the pupil to 
be careful, to be diligent in observation, to avoid hurry and heedlessness, to be atten- 
tive to the poor. Nothing can be more excellent than the rules laid down for all the 
parts of the delicate management of fever .patients: nothing more judicious than the 

general instructions arising out of the lecturer's perfect knowledge of mankind 

His prudent admonitions respecting the employment of some of the heroic remedies, as 
mercury, arsenic, and colchicum, attest his powers of observation and his practical 
merits." " The pious office of preserving and publishing his Lectures has been performed 
by Mr. Rix, with singular ability." 



INSANITY. 

A TREATISE on INSANITY and other DISEASES AFFECTING the 

MIND. By James Cowles Prichard, F.R.S. M.D. Corresponding Member 

of the Institute of France, &c. 1 vol. 8vo. 
" The author is entitled to great respect for his opinions, not only because he is well 
known as a man of extensive erudition, but also on account of his practical acquaint- 
ance with the subject on which he writes. The work, we may safely say, is the best, 
as well as the latest, on mental derangement, in the English language."— Medico-Chir. 

Rev. 

A TREATISE ON MENTAL DISEASES. By M. Esquirol. 

APHORISMS on the TREATMENT and MANAGEMENT of the 
INSANE: with considerations on Public and Private Lunatic 
Asylums, pointing out the errors in the present system. By J. G. 
Milling-en, M.D., late Medical Superintendent of Lunatic Asylum, 
Hanwell, Middlesex, &c. 1 vol. 8vo. 

"Dr. Millingen, in one small pocket volume, has compressed more real solid matter 
than could be gleaned out of any dozen of octavos on the same subject. We recommend 
his vade mecum as the best thing of the kind we ever perused." — Dr. Johnson's Review. 



FIZlTSICAIi AGENTS. 

ON THE INFLUENCE of PHYSICAL AGENTS on LIFE. By W. F. 
Edwards, M.D., F.R.S., etc. Translated from the French, by Drs. 
Hodgkin and Fisher. To which are added, some Observations on Elec- 
tricity, and Notes to»the work. 1 vol. 8vo. 

"This is a work of standard authority in Medicine ; and, in a physiological point of 
view, is pre-eminently the most valuable publication of the present century ; the experi- 
mental investigation instituted by the author, having done much towards solving many 
problems hitherto but partially understood. The work was originally presented in parts 
to the Royal Academy of Science of Paris, and so highly did they estimate the labours 
of the author, and so fully appreciate the services by him thus rendered to science and 
to humanity, that they awarded him, though a foreigner, the prize founded for the 
promotion of experimental physiology. 



CLINICAL JVEEDICIKTE. 

MEDICAL CLINIC; or, Reports of Medical CASES: By G. 
Andral, Professor of the Faculty of Medicine of Paris, etc. 
Condensed and Translated, with Observations extracted from the 
Writings of the most distinguished Medical Authors : By D. Spil- 
lan, M.D., etc., etc. ; containing Diseases of the Encephalon, &c. 
with Extracts from Ollivier's Work on Diseases of the Spinal Cord 
and its Membranes. 1 vol. 8vo. 

LECTURES on Subjects connected with CLINICAL MEDICINE. By 
P. M. Latham, M.D. Fellow of the Royal College of Physicians and 
Physician to St. Bartholomew's Hospital. 
44 We strongly recommend them [Latham's Lectures] to our readers; particularly 

to pupils attending the practice of our hospitals." — Lond. Med. Qaz. 



STANDARD MEDICAL WORKS 



SURGERY. 

ELEMENTS OF SURGERY, a Three Parts. By Robert Liston, Fel- 
low of the Royal College of Surgeons in London and Edinburgh, Surgeon 
to the Royal Infirmary, Senior Surgeon to the Royal Dispensary for 
the City and County of Edinburgh, Professor of Surgery in the London 
University, &c. &c. Third American, from the Second London Edition, 
with upwards of one hundred and sixty illustrative engravings. Edited by 

SAMUEL D. GROSS, M.D., 
Professor of Surgery, Louisville Medical Institute. Author of Ele- 
ments of Pathological Anatomy, etc., etc. 1 vol. 8vo. 

" We must not forget to mention that the volume is rendered still more attractive by the 
addition of numerous wood engravings (some of them introduced by Dr. Gross), all finely 
executed. These will be found of very considerable advantage to the student, materially 
assisting him in comprehending the explanation of morbid structure. Another admirable 
feature, is the printing of the notes in type of the same size as that of the text. This obvi- 
atesalmost entirely, whatever objections can be alleged against foot-notes."— Western Jour, 
of Med. and Surg., Dec, 1S42. 

" We are here presented with a republication of Mr. Liston's admirable and much praised 
work on Surgery, which has been subject to the alembic of a critical and learned friend, 
Dr. Gross. He has added ' copious notes and additions,' such as the progress of surgery 
in the United States demands in order to meet the wants of the surgeon. Professor Gross 
has also given an entire article on Strabismus, and another on Club Feet, which were wholly 
omitted in the English copies. They may be regarded important, inasmuch as they give a 
completeness to an otherwise unfinished treatise. The execution of the book is good; the 
paper firm, and well secured in the bindine. The plates are uniformly well executed, and 
the impressions distinct."— Boston Med. and Surg. Jour. 

" In another essential feature this edition is greatly improved. With the principles is 
taught also with it the practice of surgery, and both morbid structure and operations are 
douhly described ; first by the author and editor, and next by the graver of the artist."— 
Bull. Med. Scien. 

1 Mr. Liston's reputation as a clear, accurate, and scientific surgical writer, is so widely 
known and admitted, that formal panegyric is quite unnecessary. Dr. Gross has discharged 
his duties as editor, with all the sound sense, accurate discrimination, and experienced 
judgment, which all who knew him expected. The additions and notes are indeed profitable 
and interesting ; and our only regret is, that they are not still more numerous than they are. 
The volume is inscribed to Professor Parker, of the College of Physicians and Surgeons in 
this city, — the beauty of its typography, and 'getting up,' will be readily taken forgranted 
by a.11 who know the publishers,— and the illustrative engravings are executed in a style 
very creditable to American art."— N. Y. Lancet. 

" Mr. Liston has seen much, thinks accurately, and speaks independently. From a volume 
written by such a man, more really valuable practical instruction is to be derived than from 
all the books that were ever compiled." — Western and Southern Med. Recorder. 

" This is a work of established reputation. It has gone through two editions in Great 
Britain, and the same number in this country. The additions of the American edition are 
copious, and add materially to the value of the work."— Amer. Jour. Med. Sciences. 

" The author is bold and original in his conceptions, accurate in deductions, plain 
and concise in style; a combination of good qualities not often found united in a single 
volume. The no4es and additions, by Prof. Gross, are well arranged and judicious, sup- 
plying some evident deficiencies in the original work." — Western Lancet. 

LECTURES OF SIR ASTLEY COOPER on the PRLNCIPLES 
and PRACTICE of SURGERY, with additional Notes and 
Cases. By Frederick Tyrrell, Esq., Surgeon to St. Thomas's 
Hospital, and to the London Ophthalmic Infirmary. 1 vol. 8vo. 

LECTURES ON THE PRINCIPLES OF SURGERY. By John 

Hunter, F.R.S. With Notes by James F. Palmer, Senior Surgeon to 

the St. George's and St. James' Dispensaries, &c. &c. With Plates. 

1 vol. 8vo. 

" We cannot bring our notice of the present volume to a close without offering our 

testimony to the admirable manner in which the editor and annotator has fulfilled his 

part of the undertaking. The advancements and improvements that have been effected, 

up to our own day, not only in practical surgery, but in all the collateral departments, 

are constantly brought before the reader's attention in clear and concise terms." — 

Brit. # Far. Med. Rev. 



JOHN HUNTER'S WORKS. 

THE COMPLETE WORKS OF JOHN HUiNTER, F.R.S.,4 vols. 

8vo„ comprising his Lectures on the Principles of Surgery; A 
Treatise on the Teeth; Treatise on the Venereal Diseases ; Trea- 
tise on Inflammation and Gun-Shot Wounds ; Observations on 
Certain Parts of the Animal fficonomy ; and a full and comprehen- 
sive Memoir. Each of the Works is edited by men of celebrity in 
the Medical Science, and the whole under the superintendence of 



PUBLISHED BY BARRINGTON AND HASWELL. 



Jas. F. Palmer, of the St. George's and St. James's Dispensary. 
This is the only complete edition of the works of the distinguished 
physiologist ever published in this country. 

"One distinctive feature of the present edition of Hunter's works has been already 
mentioned, viz: in the addition of illustrative notes, which are not thrown in at hazard, 
but are written by men who are already eminent for their skill and attainments on the 
particular subjects which they have thus illustrated. By this means, whilst we have the 
views entire o( John Hunter in the text, we are enabled by reference to the accompanying 
notes, to see wherein the author is borne out by the positive knowledge of the present "day, 
or to what extent his views require modification and correction. The names of the 
gentlemen who have in this manner assisted Mr. Palmer, are guarantees of the successful 
performance of their task. 1 '— Med. Gaz. 



HYSTERIA. 



AN ESSAY ON HYSTERIA, being an analysis of its irregular and aggra- 
vated forms; including Hysterical Hemorrhage and Hysterical Ischuria. 
With numerous Illustrative and Curious Cases. By Thomas Laycock, 
House Surgeon to the York County Hospital. 1 vol. 8vo. 



UTERUS. 

LECTURES on the FUNCTIONS and DISEASES of the WOMB, 

by Charles Waller, M.D., Bartholomew's Hospital. 

ON DISEASES of the UTERUS and its APPENDAGES, by M. 

Lisfranc, La Pitie Hospital. 

ON DISEASES of the PUERPERAL STATE, by J. T. Ingleby, 
Edinburgh. 1 vol. 8vo. 

" We can very cordially recommend them as affording a concise and practical exposition 
of the pathology and treatment of a most important class of diseases, and which cannot be 
too attentively studied." — N. Y. Lancet. 

" The present volume contains a short and succinct practical account of the principal mor- 
bid states either of the functions or the structure of the womb, the best methods of dis- 
tinguishing them, and the means which experience has shown to be the most effectual in 
removing them. The reader will find that he obtains, in a small compass, a distinct view 
of the nature and treatment of each disorder."— -Edinb. Med. and Surg. Joum. 



COOTSTXPATZOCT. 

A TREATISE on the CAUSES and CONSEQUENCES of HABITUAL 
CONSTIPATION. By John Burne, M.D., Fellow of the Royal College 
of Physicians, Physician to the Westminster Hospital, &c. 1 vol. 8vo. 
" For some interesting cases illustrative of this work, the author is indebted to Dr.Williams, 

Dr. Stroud, Dr. Callaway, Mr. Morgan, Mr. Taunton, Dr. Roots, Sir Astlev Cooper, Sir 

Benjamin Brodie,Mr. Tupper, Mr. Bailer, Dr. Paris, Mr. Dendy, Dr. Hen. U.Thomson," 

&c. — Preface. 



U&XOTAR.1T BXSEASXZ5. 

URINARY DISEASES and their TREATMENT. By Robert Wil- 
lis, M.D., Physician to the Royal Infirmary for Children, &c. &c. 

"We do not know that a more competent author than Dr. Willis could have been 
found to undertake the task ; possessing, as it is evident from his work that he does 
possess, an accurate acquaintance with the subject in all its details, considerable per- 
sonal experience in the diseases of which he treats, capacity for lucid arrangement, and 
a style of communication commendable in every respect." 

" Our notice of Dr. Willis's work must here terminate. It is one which we have read 
and trust acain to read with profit. The history of discovery is successfully given; cases 
curious and important, illustrative of the various subjects, have been selected from many 
new sources, as well as detailed from the author's own experience, chemical analyses, 
not too elaborate, have been afforded, which will be most convenient to those who wish 
to investigate the qualities of the urine in disease; the importance of attending to this 
secretion in order to a proper understanding of disease is strongly insisted upon ; in 
short, a book has been composed,' which was much required, and which we can conscien- 
tiously and confidently recommend as likely to be useful to all classes of practi- 
tioners."— Brit. 8c For. Med. Rev. 

AMUSSAT'S LECTURES on the RETENTION of URINE, CAUSED by 
STRICTURES of the URETHRA, and on the Diseases of the Prostate, 
translated from the French by James P. Jervey, M.D. 



10 



STANDARD MEDICAL WORKS 



EPIDEMICS OF THE MIDDLE AGES. 

EPIDEMICS of the MIDDLE AGES. From the German of I. F. C. 
Hecker, M.D., &c. &c. Translated by R. G. Babington, M.D. F.R.S.— 

No. I.— THE BLACK DEATH IN THE 14th CENTURY. 

" Hecker's account of the ' Black Death,' which ravaged so large a portion of the globe 
in the fourteenth century, may be mentioned as a work worthy of our notice, both as 
containing many interestingdetails of this tremendous pestilence, and as exhibiting a 
curious specimen of medical hypothesis.'— Cyclopedia of Practical Medicine— History of 
Medicine by Dr. Bostock. 

No. II.— THE DANCING MANIA. 

'• Medical History has long been in need of the chapter which this book supplies ; and 
the deficiency could not have been remedied at a better season. On the whole, this 
volume ought to he popular; to the profession it must prove highly acceptable, as con- 
veying so much information, touching an important subject which had almost been 
suffered to be buried in oblivion, and we think that to Dr. Babington especial thanks 
are due for having naturalised so interesting a production. The style of the translation, 
we may add, is free from foreign idioms: it reads like an English original.— Lond. 
Med. Oaz. 

PHYSIOLOGY AND HYGIENE. 

ESSAYS ON PHYSIOLOGY AND HYGIENE; viz: 

I. Reid's Experimental Investigation into the Functions of the Eighth 

Pair of Nerves. 

II. Ehrenberg's Microscopical Observations on the Brain and Nerves 

(with numerous engravings). 

III. On the Combination of Motor and Sensitive Nervous Activity; 

by Professor Stromeyer, Hanover. 

IV. Vegetable Physiology. 

V. Experiments on the Brain, Spinal Marrow, and Nerves. By 
Prof. Mayer, of Bonn (with woodcuts). 

VI. Public Hygiene. 

VII. Progress of the Anatomy and Physiology of the Nervous Sys- 

tem, during 1836. By Professor Muller. 

VIII. Vital Statistics. 1 vol. 8vo. 



ANATOMICAL EXAMINATIONS. 

EXAMINATIONS in ANATOMY and PHYSIOLOGY; being a 
complete series of Questions and Answers; designed and intended 
as preparatory to Examinations at the different Medical Schools 
throughout the United States. To which are annexed, Tables of 
the Bones, Muscles, and Arteries. By Thomas Sydenham Bryant, 
M.D., Surgeon U. S. Army. 

" This is a very useful manual of anatomy. We have pleasure in recommending it to the 
favourable notice of students. They will find it of immense service in preparing for exami- 
nations." — N. Y. Lancet. 

THE LONDON DISSECTOR, OR GUIDE TO ANATOMY; 

for the use of students : comprising a description of the muscles, 

vessels, nerves, lymphatics, and viscera of the human body, as they 

appear on dissection ; with directions for their demonstration. 

Revised and corrected by Edward J. Chaisty, M.D., &c, &c. 

1 vol. 12mo. 

" Although there are several of these dissecting-room companions, there is not one in the 
whole catalogue that wears better, from its intrinsic value, than the old London Dissector. 
With the improvements of this excellent edition, carefully revised, it will prove a very 
economical as well as certain assistant ; and it therefore commends itself to the student."— 
Boston Med. and Surg. Jour. 



PUBLISHED BY BARRINGTON AND HASWELL. 11 



JUST PUBLISHED, 
STOKES AMD BELXi. 

LECTURES ON THE THEORY AND PRACTICE OF PHY- 
SIC. By William Stokes, M.D., Lecturer at the Medical School, 
Park Street, Dublin : Physician to the Meath County Hospital, 
etc., etc., and John Bell, M.D., Lecturer on Materia Medica and 
Therapeutics : Member of the College of Physicians, Philadelphia, 
and of the American Philosophical Society, etc., etc. Second 
American Edition. 2 vols. 8vo. 

"The work has now assumed the form of a quite complete system of medicine, equally- 
valuable as a text-book to the student, and a book of reference to the practitioner." " We 
know of no book of the kind which we would more readily place in the hands of a student, 
or to which we would more readily refer the practitioner, for a hasty investigation of a sub- 
ject." — New Eng. Quart. Journ. of Med. and Surg. 

"Stokes and Bell's Practice being among the best works extant on practical medicine, 
will at once commend itself to the practitioners of our country. It is not going too far to 
declare, that no physician, whether his experience be large or small, should be without this 
work in his library; and, having it there, he should study its various parts with care and 
attention." — Western Lancet. 

"A second edition of this work of established reputation, is sent out from the press of 
Messrs. Barrington and tlaswell, Philadelphia. No change in the mind of the medical public, 
touching the worth of this very celebrated series of medical lectures, has been wrought by 
the advent of later publications on the same subjects. It is just as popular as ever, and we 
believe, at this moment, is exerting a far more extensive influence than was ever predicted 
by the warmest personal friends of the two learned authors." — Boston Med. and Surg. Jour. 

The following is from the pen of a distinguished Professor in one of the Medical 
Schools in the West. 
" We cordially recommend the joint labours of two such distinguished physicians as 
Drs. Stokes and Bell to the notice of the medical profession. They will be found to em- 
body the principles and practice of medical science down to the present moment." — Louis- 
ville Journal. 



OUTLINES OF GENERAL PATHOLOGY. By George Freckleton, 
M.D., Fellow of the Royal College of Physicians. 

OBSERVATIONS on the PRINCIPAL MEDICAL INSTITUTIONS 
and PRACTICE of FRANCE, ITALY, and GERMANY: with Notices 
of the Universities, and Cases from Hospital Practice: With an Appen- 
dix on ANIMAL MAGNETISM and HOMCEOPATHY. By Edwin 
Lee, Member of the Royal College of Surgeons, tfcc. 1 vol.Svo. 
" Mr. Lee has judiciously selected some clinical cases, illustrating the practice pursued 

at the different hospitals, "and he has wound up the volume with an amusing account of 

animal magnetism and homoeopathy — those precious effusions of German idealty, for 

which we refer to the work itself.— Medico -Ckirtirg. Rev. 

BOUILLAUD ON ACUTE ARTICULAR RHEUMATISM IN GEN- 
ERAL. Translated from the French, by James Kitchen, M.D., Philada. 

MEDICAL AND TOPOGRAPHICAL OBSERVATIONS upon the 
MEDITERRANEAN and upon PORTUGAL, SPAIN, AND OTHER 
COUNTRIES. By G. R. B. Horner, M.D., Surgeon U. S. Navy, 
and Honorary Member of the Philadelphia Medical Society. With En- 
gravings. I vol. 8vo. 

" An uncommonly interesting book is presented tothose who have any disposition to 
know the things medical in Portugal, Spain, and other countries," and " will doubtless 
be read, also, with marked satisfaction by all who have a taste for travels.— Bost. Med. 
and Surg. Jour. 

AN ESSAY ON DEW, and several Appearances connected with it, 
by William Charles Wells, M.D.,F.R.S., etc. 

ON DENGUE; ITS HISTORY, PATHOLOGY, AND TREATMENT. 
By S. Henry Dickson, M.D., Professor of the Institutes and Practice 
of Medicine in the Medical College of S.C. 



12 STANDARD MEDICAL WORKS, ETC. 



MISCELLANEOUS— Continued. 

HINTS ON THE MEDICAL EXAMINATION OF RECRUITS FOR 
THE ARMY; and on the Discharge of Soldiers from the Service on 
Surgeon's Certificate : Adapted to the Service of the United States. By 
Thomas Henderson, M.D., Assistant Surgeon U. S. Army, &c, &c. 

MEDICAL NOTES AND REFLECTIONS. By Henry Holland, M.D.; 
F.R.S., Fellow of the Royal College of Physicians, and Physician Extra- 
ordinary to the Queen. 

THE MEDICAL PROPERTIES oTthe NATURAL ORDER RANUN- 
CULACE^E.&c, &c. By A. Turnbull, M.D. 

Prof. HORNER'S NECROLOGICAL NOTICE OF DR. P. S. 
PHYSIC K ; Delivered before the American Philosophical Society, 
May 4, 1838. 

THE LIFE OF JOHN HUNTER, F.R.S. By Drewry Ottley. 
1 small vol. 8vo. 
"In the summing up of Mr. Hunter's character, Mr. Ottley exhibits equal judgment and 
candour. 1 '-- Brit. $ For. Med. Rev. 

ESSAY UPON THE QUESTION, IS MEDICAL SCIENCE FAVOR- 
ABLE TO SCEPTICISM? By James W. Dale, M.D., of New- 
castle, Delaware. Pamphlet. 

METEOROLOGICAL REGISTER for the years 1826-30 ; from Observa- 
tions made by Surgeons of the Army and others at the Military Posts of 
the United States. Prepared under the direction of Thomas Lawsow, 
M.D., Surgeon-General U.S.A. 



In Press, 

EV ANSON 6l HXAUNTSELL. 

A PRACTICAL TREATISE ON THE MANAGEMENT AND DIS- 
EASES OF CHILDREN. By Richard T. Evanson, M.D., Professor 
of Medicine, — and Henry Maunsell, M.D., Professor of Midwifery 
in the Col- of Surgs. in Ireland. From the 4th Dublin edition. Edited 
by D. F. Condie, M.D. 

"The authors of the work before us, have had the advantage of investigating the 
subject of Infantile Diseases, conjointly in a public institution— an advantage which 
no private medical man, however extensive his practice, could probably have. The 
observations being made conjointly too, offer a greater guarantee of correctness and 
authenticity, than if they emanated from a single source, however respectable. From 
their acquaintance, also, with foreign works, they have been able to bring up the 
Anatomy, Physiology, Pathology, and even Therapeutics, to a far higher level than is 
to be found in any previous work in the English language. 

" The second chapter embraces the Management and Physical Education of Children. 
This chapter ought to be printed in gold letters, and hung up in the nursery of every 
family. It would save many lives, and prevent much suffering." — Medico- Chirurg. Rev. 

"We know of no work to which, on the whole, so little can be objected in matter or 
manner. It is an elegant and practical compendium of Infantile Diseases; a safe 
guide in the Management of Children ; and completely fulfils the purposes proposed."— 
British Annals of Medicine, No. VIII. 



B. fy H. continue to publish 

THE SELECT MEDICAL LIBRARY 

AND BULLETIN OF MEDICAL SCIENCE. 

EDITED BY JOHN BELL, M.D., 
AT FIVE DOLLARS PER ANNUM, IN ADVANCE. 



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BARRINGTON & HASWELL. 



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LEE'S OBSERVATIONS on the PRINCIPAL MEDICAL INSTI-^ 

TUTIONS and PRACTICE of FRANCE, ITALY, and GER- & 

MANY, <fcc., with an Appendix on ANIMAL MAGNETISM and ! $ 

HOMOEOPATHY. f-g 

JOHNSTONE'S SYLLABUS of MATERIA MEDICA. | 3 

LATHAM'S LECTURES ON CLINICAL MEDICINE. J 



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A TREATISE ON TETANUS, by Thomas B. Curling. Iff 

BOUILLAUD ON ACUTE ARTICULAR RHEUMATISM in l£ < 80 

general. Translated from the French, by James Kitchen, M.D. 



PRACTICAL OBSERVATIONS on DISEASES of the HEART, ^ . f 
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WEATHERHEAD on DISEASES of the LUNGS ; considered especi- >_£ < $ 80 
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PRICHARD on INSANITY and other DISEASES affecting the MIND. 

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DAVIDSON and HUDSON'S ESSAYS on the SOURCES and MODE 
OF ACTION OF FEVER 8 sheets. . . . .80 



MACROBIN'S INTRODUCTION to the STUDY of PRACTICAL MEDI- 
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SIR JAMES CLARK on the SANATIVE INFLUENCE of CLIMATE. 

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14 



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CHANGES of the BLOOD in DISEASE. Translated from the French of 

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SIR CHARLES BELL'S INSTITUTES OF SURGERY. Arranged in 

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EPIDEMICS of the MIDDLE AGES. viz. Vie Black Death and Dancing 
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Natural order RANUNCULACE/E, &c. &c. | £ 

THE GUMS ; their Structure, Diseases, Sympathies, &c. By George }>.£ 

Waite. I w 

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85 



1 25 



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EDWARDS on the INFLUENCE of PHYSICAL AGENTS on LIFE: 

with observations on ELECTRICITY, &c. 10 sheets. . . .160 



HORNER'S NECROLOGICAL NOTICE OF DR. P. S. PHYSICK.^ . f 
IS MEDICAL SCIENCE FAVOURABLE TO SCEPTICISM ? | f | 

By Dr. Dale, of Newcastle, Delaware. } J~ { 30 

ON DENGUE; its HISTORY, PATHOLOGY, and TREATMENT. | m 



By Prof. Dickson of S. C. 



THE FOLLOWING ESSAYS ON PHYSIOLOGY AND HY ■) 
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with numerous Engravings. 
On the Combination of Motor and Sensitive Nervous Activity ; by 

Prof. Stromeyer, Hanover. 
Vegetable Physiology. 
Experiments on the Brain, Spinal Marrow, and Nerves. By Prof. 

Mayer, of Bonn ; with wood cuts. 
Public Hygiene. 
Progress of the Anatomy and Physiology of the Nervous System, 

during 1836. By Pro. Muller. 
Vital Statistics. 
REID on the FUNCTIONS of the EIGHTH PAIR of NERVES. J L 



so 



1 25 



FRECKLETON'S OUTLINES of GENERAL PATHOLOGY. 7 sheets. . 75 



URINARY DISEASES, and their TREATMENT. By R. Willis, M.D., &c. 

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MILLINGEN'S CURIOSITIES of MEDICAL EXPERIENCE. 15 sheets. 1 50 



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ANDRAL'S MEDICAL CLINIC: Diseases of the Encephalon, Spinal Cord, 

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LECTURES on the PHYSIOLOGY and DISEASES of the CHEST. By 

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LECTURES on BLOOD-LETTING. By Dr. Clutterbuck. 5 sheets. . 65 



MEDICAL and TOPOGRAPHICAL OBSERVATIONS upon the MEDI- 
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G. R. B. Horner, Surgeon U. S. N., <Scc. Illustrated tcith Engravings. 
9 sheets. . . . . . . . 1 00 



MAGENDIF/S LECTURES on the BLOOD: its Changes during Disease, 

&c. 12 sheets. . . . . . . . 1 25 



The ECLECTIC JOURNAL of MEDICINE, by John Bell, M.D., &c, from 
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HOLLANDS MEDICAL NOTES and REFLECTIONS. 16 sheets. . 1 60 



ARMY METEOROLOGICAL REGISTER for the YEARS 1S26,^| 

1827, 1828, 1829, and 1830. 
HINTS on the MEDICAL EXAMINATION of RECRUITS for the Ig 

ARMY; and on the Discharge of Soldiers from the Service on ; -f= i 
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65 



MACARTNEY on INFLAMMATION. 5 sheets. . . .0 50 



BURXE on HABITUAL CONSTIPATION— its Causes and Consequences. 
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A PRACTICAL TREATISE on VENEREAL DISORDERS, &c.^ v f 
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AMUSSAT'S LECTURES on the RETENTION of URINE, >j; < 75 
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ESQUIROL on MENTAL DISEASES. 1 I f 

AN ESSAY ON HYSTERIA. With numerous Illustrative and Curious )>| <j 100 
Cases. By Thomas Laycock. j o I 

CLINICAL REMARKS on some Cases of LIVER ABSCESS pre-^i f 
senting externally. By John G. Malcolmson, M.D., Surgeon Hon. E. I. | « | 
C. Service, &c. l«j ftK 

THOMSON'S NOTICES of INFLAMMATORY AFFECTIONS {■=) 
of the INTERNAL ORGANS after EXTERNAL INJURIES and I ^ | 
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The ECLECTIC JOURNAL of MEDICINE, by John Bell, M.D., &c, from 

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GOOCH'S PRACTICAL COMPENDIUM of MIDWIFERY. 14 sheets. . 1 00 



GRAVES'S CLINICAL LECTURES. With Nates and Fifteen additional 
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ELEMENTS OF SURGERY, in Three Parts. By Robert ListojO f 
Fellow of the Royal College of Surgeons in London and Edinburgh, « | 
&c. Third American, from the Second London Edition, with upwards I ©J 
of one hundred and sixty illustrative engravings. Edited by Samuel D. ji | •* 25 
Gross, M.D., Professorof Surgery, Louisville Medical Institute. Author £j | 
of Elements of Pathological Anatomy, etc.. etc. 1 vol. 8vo. J ^ 

THE HISTORY, PATHOLOGY, AND TREATMENT OF PUER-^ f 
PERAL FEVER AND CRURAL PHLEBITIS. By Drs. Gordon, | * | 
Hey, Armstrong, and Lee; with an INTRODUCTORY ESSAY 12 j *, fin 
by Charles D. Meigs. M.D., Professor of Obstetrics and the Diseases pS^, * 1 
of Women and Children in the Jefferson Medical College, Philadel- j ^ | 
phia. 1 vol. Svo. . . . . • " • J L 

DERANGEMENTS, PRIMARY AND REFLEX, OF THE ORGANS 
OF DIGESTION. By Robert Dick, M.D., author of " A Treatise on Diet 
and Regimen." 1 vol. Svo. 10 sheets. . . . . 1 40 

DISEASES OF THE LIVER AND BILIARY PASSAGES, by^| „• f 
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Edinburgh; and CLINICAL ILLUSTRATIONS OF THE LIVER lj= { 1 60 
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A TREATISE ON THE DISEASES OF CHILDREN, WITH^ . f 
DIRECTIONS FOR THE MANAGEMENT OF INFANTS; by | g | 
the late Michael Underwood, M.D. From the ninth Euglish edition, } J <; 1 75 
with notes by S. Merriman, M.D., and Marshall Hall 
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LECTURES ON THE FUNCTIONS AND DISEASES OF THE" 
WOMB; by Charles Waller, M.D., Bartholomew's Hospital. 

ON DISEASES OF THE UTERUS AND ITS APPENDAGES; I SJ , m 
by M. Lisfranc La Pitie Hospital. f-g ] 

ON DISEASES OF THE PUERPERAL STATE; by J. T. Ingleby | o | 
Edinburgh, 1 vol. 8vo. J "" L 

APHORISMS ON THE TREATMENT AND MANAGEMENT OF 

THE INSANE ; by J. G. Millingen, M.D. 1 vol. Svo. 4 sheets. . 38 

A PRACTICAL DICTIONARY OF MATERIA MEDICA, Includ-1 f 
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number of Extemporaneous Formulas: together with important Toxi- 1 § J 
cological Observations ; on the Basis of Brande's Dictionary of Materia \i?.} 2 25 
Medica and Practical Pharmacy: by John Bell, M.D., Lecturer on | g j 
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OUTLINES OF PATHOLOGICAL SEMEIOLOGY. Translated from 
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ARETyEUS ON THE CAUSES AND SIGNS OF ACUTE AND 
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LECTURES ON THE MORBID ANATOMY, NATURE, AND") . f 
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the late John Armstrong, M.D., Author of " Practical Illustrations of ?>_|< 2 /5 
Typhous and Scarlet Fever," &c. Edited by Joseph Rix, Member of j £ \ 
the Royal College of Surgeons. 1 vol. 8vo. J °* L 

BLUNDELL'S LECTURES ON THE PRINCIPLES AND PRACTICE 
OF MIDWIFERY. Edited by Charles Severn. lvol.Svo. 19 sheets. . 150